Insurance Claims Specialist
4 weeks ago
As an Insurance Claims Specialist at SCA Health, you will play a vital role in ensuring the accuracy and efficiency of patient account resolutions. Your primary responsibility will be to research and process credit balances, refunds, and insurance check refunds requests in a timely manner. You will also be responsible for sending overpayment letters to carriers, reviewing and validating written requests from insurances, and submitting payer disputes as needed. Additionally, you will be required to answer calls and inquiries from third-party carriers regarding overpayments or refunds requests, follow up on outstanding credit accounts, and calculate and verify expected pay based on contractual allowances for multiple payers. You will also be responsible for documenting all work performed in the patient accounting system and reviewing patient account history and notes to determine the next step required for resolution.
Key Responsibilities:
Research and process credit balances, refunds, and insurance check refunds requests
Send overpayment letters to carriers
Review and validate written requests from insurances
Submit payer disputes as needed
Answer calls and inquiries from third-party carriers regarding overpayments or refunds requests
Follow up on outstanding credit accounts
Calculate and verify expected pay based on contractual allowances for multiple payers
Document all work performed in the patient accounting system
Review patient account history and notes to determine the next step required for resolution
Requirements:
Excellent telephone skills and customer service skills
High level of self-organization and tracking
Works independently, is a self-starter with a high level of initiative
Strong communication skills, both verbally and in writing
Possesses accurate judgment, especially handling insurance claims and dealing with patient accounts
Versatile and willing to coordinate with and participate in, when necessary, all other aspects of the Business Office
Ability to handle confidential information
Possess basic knowledge of medical terminology
Possess knowledge of health insurance billing
Read and interpret EOBs and can calculate expected allowances based on payer contracts to determine reason for balance
Possess knowledge of typing, word processing, spreadsheet, and computer billing systems
Must be dependable and reliable
Ability to multi-task, think critically, and solve problems
One or more years of experience in a related position working in a medical office, hospital, outpatient surgery center, or related field with core duties related to medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements, or related training/certificates/diplomas
What We Offer:
Competitive hourly rate of USD $20.00 to USD $25.00
Why Join Us:
SCA Health is a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge. We connect patients to physicians in new and differentiated ways, and we have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care. We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients. We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines. The new SCA Health represents who we are today and where we are goingand the growing career opportunities for YOU.
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