Insurance Claims Specialist

4 weeks ago


Toledo, Ohio, United States University of Toledo Physicians Full time
Job Title: Insurance Follow Up Specialist

At University of Toledo Physicians, we are committed to delivering exceptional patient care and medical discovery. As an Insurance Follow Up Specialist, you will play a vital role in ensuring the smooth operation of our revenue cycle process.

Key Responsibilities:
  • Document all responses and actions taken to resolve claims or account balances in our practice management system.
  • Develop strong communication skills and a positive attitude to interact with internal and external customers, including patients, insurance companies, and vendors.
  • Follow established workflow processes to ensure correct registration, coding, payment/adjustment posting, and insurance processing of claims.
  • Conduct verbal and written inquiries to determine the reasons for unpaid or denied claims and work towards resolution.
  • Manage claims in assigned worklists to meet or exceed productivity standards.
  • Participate as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.
  • Ensure claims are submitted to the appropriate responsible party within designated filing limit guidelines and prioritize claim resolution.
  • Recognize and research problematic trends regarding non-payment to implement preventive measures and increase cash collections.
  • Travel to practice locations to provide on-site support and participate in regular meetings with practice leadership to promote positive revenue cycle performance outcomes.
  • Maintain the confidentiality of patient records and accounts.
  • Actively participate in staff meetings and process improvement planning sessions.
  • Maintain a clean and orderly work area, ensuring all source documents are stored electronically on the shared network.
  • Understand HIPAA policies and procedures and practice in a manner that maintains the confidentiality of protected health information (PHI) in compliance with HIPAA.
Requirements:
  • Education: High School diploma or equivalent
  • Skills:
    • A basic understanding of insurance requirements and regulations, contract benefits, credit and collection procedures, financial assistance programs, and medical terminology.
    • Advanced reading, writing, and oral communication skills, as well as the knowledge to perform mathematical calculations.
    • Interpersonal skills necessary for making patient and third-party payer contacts, with the ability to work with interruptions from coworkers or other internal customers needing assistance with patient accounts.
    • Analytical and critical thinking ability to diagnose account issues and active listening skills to provide service excellence.
    • Demonstrated project and time management skills and the ability to work effectively over the phone and in a team environment.
    • Demonstrated proficiency in data entry and computers.
Preferred Qualifications:
  • Years of experience: 2-5 years in resolving insurance denials and/or revenue cycle
  • Skills:
    • Knowledge of CPT and ICD terminology.
    • Familiarity with billing software.
    • EPIC experience.
Working Conditions:

Works in an open office environment with good ventilation, lighting, and access to equipment and materials required for daily work functioning.



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