Insurance Billing Specialist

Essential Job Functions

• Reviews, edits, and corrects claims, as necessary, checking for accuracy and readiness of claims to be submitted through the electronic health record (EPIC).
• Prepares and submits claims to insurance carriers and intermediaries, i.e. releasing electronic claims, printing paper claims, and/or secondary claim as required per individual payer.
• Works with various departments to ensure that held claims will be released to the payer within timely filing limits.
• Performs follow-up procedures, inquiring on the status of unpaid claims via phone call or various payer portals, to ensure timely payment of insurance claims.
• Responds to routine patient and insurance company inquiries and problems.
• Researches denials/non-covered charges and re-submits or appeals, as necessary.
• Reviews late charges for re-billing or adjustment of claims, as necessary.
• Reviews insurance eligibility or coverage changes to ensure accuracy of information, resolve any outstanding issues, and rebill claims when necessary.
• Updates necessary changes to patient demographics and/or insurance information.
• Reviews accounts with insurance credit balances and determines if a refund or other action is necessary to settle account.
• Accommodates patient requests and inquiries promptly and courteously, answering incoming calls to the Business Office, educating patients on their financial responsibilities to the organization, accepting payment, setting up payment plans, etc.
• Performs other duties as deemed necessary for the continued viability and success of the department and organization as a whole.
• Other job duties and responsibilities as assigned to effectively meet the needs of the patients, the department, and the organization as a whole.

Competencies

• Accountability – Ability to accept responsibility and account for his/her actions.
• Communication – The ability to get one’s ideas across to others through oral or written means and to understand the ideas of others through effective listening skills.
• Customer Oriented – Ability to take care of the customers’ needs while following company procedures.
• Detail Oriented – Ability to pay attention to the minute details of a project or task.
• Organized – Possessing the trait of being organized or following a systematic method of performing a task.
• Ethical – Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Accuracy – Ability to perform work accurately and thoroughly.
• Reliability – The trait of being dependable and trustworthy.
• Research Skills – Ability to design and conduct a systematic, objective, and critical investigation.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Education

• High School Graduate or General Education Degree (GED): Required
• Associate’s Degree (two year college or technical school) Preferred, Field of Study: Business Related

Experience

• 1-2 years of healthcare billing experience preferred
• 1-2 years of EPIC experience preferred

Computer Skills

• Microsoft Office proficiency