Insurance Services Specialist
3 weeks ago
Insurance Services Specialist
Pay: $20.00 - 22.00 per hour
The Insurance Services Specialist is responsible for submitting and collecting payments from insurance companies for various companies of Embark. This job opportunity is suited for a skilled insurance billing specialist who can independently coordinate and manage all phases of insurance billing for mental health services.
The main responsibilities for this role include invoicing, claims submission, denial management and claims receivable management. The Insurance Services Specialist will be required to interface with operational managers, operational staff, insurance companies, utilization review teams, and families.
Responsibilities:
Ensure timely and accurate verification of benefits for commercial and Medicaid insurance coverage as related to Behavioral Health coverage
Ensures the validity and integrity of all patient insurance records
Ensure timely and accurate processing of invoices and claims; responsible for submitting clean electronic and paper claims to insurance companies
Responsible for investigation and correction of rejected claims from clearinghouse and/or insurance companies
Responsible for timely responses to insurance denials, monitoring for trends, and providing feedback on operational processes
Responsible for working A/R aging report while maintaining account status records and collection efforts in centralized note system
Responsible for processing and responding to requests for information and records from insurance companies
Responsible for timely response on requests for refunds as received from insurance company; requests will be validated for accuracy and challenged when not accurate
Responsible for invoicing of patient co-pays and deductibles, private pay collections and A/R management
Monitor assigned accounts to identify overdue payments and issue refunds on overpayments
Make recommendations on adjustments, refunds, and outside collection activity in alignment with company policy and procedures
Partner will utilization review team to ensure timely billing to third party payors
Participate in regular billing coordination meetings and provide feedback for problem solving with A/R issues
Engage in cash application process, making sure all cash receipts are applied accurately and timely
Provide feedback to program on how to ensure compliance while maximizing revenue
Qualifications:
A minimum of 2 years prior work experience in medical billing and accounts receivable, preferable in a medical or behavioral-healthcare environment
Experience with electronic claims filing
Working knowledge of Windows-based applications, including Outlook, Word and Excel
Hands-on experience with accounting software and familiarity with MS Excel to include strong analytical skills
Strong and professional communication skills
Skilled in negotiation and problem-solving aptitude
Patience and ability to manage stress and maintain confidentiality
Excellent written and verbal communication skills
Exceptional organizational skills and attention to detail
High School/GED required, Associate degree preferred
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