Billing-Insurance Collections Specialist

Description

Insurance Collections Specialist is responsible for ensuring all organization unpaid insurance claims are collected according to practice contractual agreements and internal policy.

Requirements

Responsibilities and Duties:

• Maintain active login and passwords at all applicable carrier websites.
• Stay abreast of all coding guidelines and criteria for carriers/payors assigned to you.
• Maintain a current list for the department of carrier timely filing and re-filing windows.
• Investigate and resolve unpaid services billed to carriers.
• Update the department director of any changes in carrier coverage and coding policies.
• Notify department director immediately of payment changes and trends noticed from denials.
• Apply claim corrections to denied services and resubmit.
• Work the full patient account (ins responsible claims) at all times
• Process corrected claims electronically through practice management system.
• Processing corrections through other portals to occur only through strict limited department approved policies.
• Ensure all paper claims generated by your work have appropriate attachments for the appeal.
• Ie auto, work comp, etc
• Draft cover letter / or complete carrier appeal form(s) as appropriate to send with claims.
• Ensure appealed claims are mailed to correct alternate addresses if required.
• Ensure past claims are corrected and re-filed upon implementation of any new internal policy.
• Daily correct all unpaid claims identified by payments posted the prior business day.
• Maintain & review daily a “rolling” 31 day pending logs ensuring past appealed claims are paid.
• Work a monthly generated report on all past due A/R unpaid claims.
• Prioritize the appeal of unpaid claims according to department policy, claim amount, and each carrier timely re-filing window.
• Initiate write offs and adjustments as appropriate for approval – with strict adherence to department policy.
• Scan all supporting work files as determined by department supervisor.
• Ensure compliance with medical coding policies and guidelines.
• Abide by HIPAA and other regulatory compliance guidelines.
• Participate in cross training other staff on duties related to this job description.
• Engage in cross training on other practice positions in the organization.
• Advise department supervisor of ongoing carrier issues before timely filing window expires.

Qualifications:

• High school diploma, Associate or Bachelor degree preferred
• No less than 3 years medical out-patient Insurance collection experience
• CPC, CCS certification from AAPC or AHIMA is a plus
• Continuing education obtained as needed to perform duties
• Excellent computer skills to include windows based applications
• Outstanding organizational skills and accuracy in data entry
• Strong problem solving skills
• Ability to understand and implement from both verbal and written instructions
• Experience with interpreting Medicare, Medicaid, Commercial & other payor type EOB’s