Medical Insurance Specialist

4 weeks ago

Lake Forest, United States KIM TANG MD INC Full time

**JOB TITLE**: MEDICAL INSURANCE SPECIALIST

**E**MPLOYER**:KIM TANG MD INC

**DEPARTMENT**: INSURANCE

**REPORTS TO**: INSURANCE BILLING DEPARTMENT MANAGER

**EFFECTIVE DATE**: 03/01/2024

**SUMMARY**:Under direct supervision of the billing department manager this position’s daily responsibilities include but are not limited to medical claim submissions, posting insurance EOBs, processing patient payments, working accounts receivable and obtaining medical authorizations. This position requires effective communication with physicians, patients, insurance carriers, and pharmacies.

**DUTIES AND RESPONSIBILITIES**:
- Identify benefit coverage of HMO, PPO, primary, secondary or tertiary insurance coverage-
- Accurately enter insurance billing information-
- Submit requests for HMO authorizations-
- Submit medical claims to insurance companies-
- Post insurance and patient payments-
- Work accounts receivable aging - both insurance and patient accounts-
- Contact patients regarding past due account balances-
- Submit patient accounts to collections**SUPERVISORY** RESPONSIBILITIES**:
- This job has no supervisory responsibilities.**QUALIFICATIONS**:
- Minimum 1-year medical insurance department experience required.-
- Basic knowledge of CPT and ICD 10 billing codes with regards to claim submission-
- Ability to interpret insurance explanation of benefits-
- Knowledge of HMO insurance requirements - Ability to review physician orders for medical necessity and accuracy to support authorization requests.-
- Professionally communicate with patients regarding insurance questions and account balances.**COMPETENCIES**:
**Diversity** - Shows respect and sensitivity for cultural differences-
**Ethics** - Treats people with respect; Works with integrity and ethically; Upholds organizational values.-
**Attendance/Punctuality** - Is consistently at work and on time-
**Customer Service** - Manages difficult or emotional customer situations-
**Professionalism** - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.-
**Written Communication** - Writes clearly and informatively; Able to read and interpret written information.**PHYSICAL DEMANDS AND WORK **ENVIRONMENT**:
- Occasionally required to stand-
- Occasionally required to walk-
- Occasionally required to sit-
- Occasionally required to utilize hand and finger dexterity-
- Continually required to talk or hear-
- Occasional exposure to bloodborne and airborne pathogens or infectious materials-
- While performing the duties of this job, the noise level in the work environment is usually moderate.- The above is intended to describe the general content of and requirements for the performance of this job._ It is not to be construed as an exhaustive statement of duties, _responsibilities_ or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time._ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions._

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