- Determines and facilitates appropriate action for claim resolution and correct financial responsibility via DOFRs, IPA and health plan/IPA contacts. Effectively uses detailed documentation in EMR and/or billing system(s) of all activities undertaken.
- Maintains timely follow-up on outstanding insurance claims in appropriate EPIC WQs, ensuring claims are billed/rebilled within carrier filing limits. Effectively takes appropriate action on claim denials to ensure prompt resolution and follows-up on those rebilled, corrected and appealed.
- Maintains detailed documentation in software system(s) of all claims & collections activities, including rebills, all follow-up, and related correspondence with carriers, practitioners.
- Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues and identify need for escalation, report to leadership as needed.
- Informs Supervisor of problems related to insurance company payments/denials, contract pricing, and works with Supervisor and all parties involved to ensure prompt resolution.
- Meet or exceed production, quality and accuracy standards while ensuring privacy and documentation procedures are maintained. Assists with month end deadlines including AR clean up and/or providing payer trending for month end reporting as needed.
- Assists supervisor/manager in any audits or special projects. Work collaboratively with leadership and other team members to improve or challenge processes, provide trending and solutions insights and support the capability development of the team. Ability to troubleshoot and proactively anticipate potential issues.
- Investigate all insurance payments that deviate from expected payment (ie: underpayments, contracting issues. Will be responsible for maintaining spreadsheets or trackers assigned by Supervisor.
- Attendance of management meetings on a regular basis, conference calls, payer provider relations, vendors etc. Work directly with other units and departments as needed for collaboration.
- Support the AR Supervisor in all areas as needed and work other duties as assigned.
- GED / Diploma - High School required
- 2 Years - Business Admin / Healthcare / Related Field preferred
- Certified Medical Reimbursement Specialist CMRS preferred
- Certified Medical Insurance Specialist CMIS preferred
- 3 years billing in Medical Office / Hospital required
- 3 years CPT/ICD-10 guidelines and use of modifiers required
- 2 years Excel and other Microsoft office applications required
- 3 years EMR required
- 2 years EPIC EMR required
- 2 years Division of financial responsibility (DoFR) experience with training capability required
- Medical, Dental, & Vision Insurance for Full & Part Time Employees
- 401k Retirement & Matching Plan
- Generous PTO and Paid Holidays
- Continuing Education
- Reimbursement Program
- And Much More
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Insurance Specialist Sr - Antioch, United States - US Oncology Network-wide Career Opportunities
Description
OverviewHOURLY RATE (DEPENDING ON SKILLS/EXPERIENCE): $ $34.31
SCOPE: Responsible for investigating current and aged and denied insurance claims to determine appropriate action and provide resolution by determining payment status and resolving payment disputes using account notes, health plan websites and health plan customer service and appeal/escalation procedures in compliance with healthcare policies and payer contract requirements/filing limits. Help to identify aged and/or denied claim patterns to identify potential process improvements. Assists in special projects, mentoring department personnel, assisting with questions/clarifications and training as needed.
HYBRID POSITION
ResponsibilitiesRESPONSIBILITIES:
EDUCATION / TRAINING REQUIREMENTS:
LICENSES / CERTIFICATIONS / REGISTRATION:
EXPERIENCE REQUIREMENTS:
BENEFITS & PERKS:
It is the policy of Epic Care to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, age, national origin, family status (including pregnancy), marital status, military status, sensory, physical, or mental disability, genetic information, or any other factor protected by local, state or federal law, and to prohibit harassment or retaliation based on any of these factors.
Epic Care is an Alcohol and Drug-Free workplace. Learn more about Epic Care at
Our mission is safe patient care; we require all our employees to be vaccinated as such vaccinations are available and subject to the narrow exceptions provided by applicable law.
