Insurance Specialist

1 month ago

Land O' Lakes, United States Florida Medical Clinic Full time
Job Title: Insurance Specialist

At Florida Medical Clinic, we are seeking a highly skilled Insurance Specialist to join our team. As an Insurance Specialist, you will be responsible for managing accounts receivable through claim follow-up, cash collection, and denial management for services rendered by our providers.

Key Responsibilities:
  • Run and/or work various reports/work queues as instructed, including Summary/Detailed Aging Reports, Claim Control Work Queue Filters, Tasks, Mail, Denial Work Lists/AR Excel Spreadsheets, and Unbilled Items report.
  • Prepare for Monthly Divisional Meetings by maintaining a list of trends for review with Supervisor during one-on-one meeting, including trends found while working denial/AR reports and Claims Control.
  • Quality and Quantity of work: Maintain AR aged over 90 days at or less than 9%, work all accounts aged 30 days and greater by Insurance/Provider every 45 days, meet expectations for number of accounts worked daily/weekly/monthly for assigned specialty, and contact Insurance carriers to obtain claim status/confirm claims are on file and in process to pay.
Requirements:
  • Graduate of Health Insurance Specialist Certificate preferred OR High School Diploma.
  • Minimum two years medical/professional billing, insurance follow-up, and denials management experience – appeals.
  • Expert working knowledge of EOB's, copay/co-insurance/deductibles, denial codes/reasons, insurance allowables, adjustments, and an understanding of payor reimbursement methodologies and guidelines.
  • Expert knowledge of HCFA 1500 and/or UB04 claim forms.
  • Strong knowledge of major payor billing policies, including: Medicare, Medicaid, Aetna, BCBS, Cigna, Humana, Untied Healthcare, Workers' Comp and MVA.
  • Expert knowledge of CPT/HCPCS and ICD-10 codes.
  • Knowledge of charge posting and EDI functions preferred.
  • Ability to navigate payer websites/portals and other various sites to conduct research.
  • Accounting Principles, Basic Office Skills required; advanced office skills are preferred.
  • Strong communication skills (oral and written); must be able to collaborate effectively and work in a team environment.
  • Ability to work at a fast pace – meet productivity quotas while maintaining a high level of quality in work performed.
  • Detail oriented with excellent organization skills.
  • Ability to multitask and effectively manage numerous competing priorities.
  • Excellent phone skills.
What We Offer:
  • Gives you an employer that you will have pride in working for.
  • Provides excellent training programs and opportunities for growth.
  • Offers Medical Benefits including: Employer Contributions to HSA high deductible plan, Discounts at our medical facilities, Cigna Open Access OAPIN & OAP plans.
  • Supports Incentive based Wellness Programs.
  • Offers company sponsored Life Insurance with buy-up provisions.
  • Provides Dental, Vision, Long and Short Term Disability, Accident & Illness policy options.
  • Supports Paid Time Off and Holidays.
  • Gives generous 401K plan with annual 3% Employer contribution after one year of employment.
  • Values and appreciates its employees.
  • Boasts a reputation for superior health care and quality service.

We are an Equal Opportunity Employer and make employment decisions without regard to race, gender, disability or protected veteran status.

Florida Medical Clinic Orlando Health is a drug-free workplace and maintains a policy in which new hires will be required to submit to pre-employment drug testing.

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