- Will participate and maintain a culture within The Corvallis Clinic consistent with the content outlined in the Service and Behavioral Standards document. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within
- Verifies insurance coverage through Athena, insurance websites, or through phone calls to the insurance company to verify eligibility, referrals and benefit information for proper patient insurance set-up and billing, for upcoming appointments
- Works through eligibility issues found in Athena for the departments throughout the Clinic each day
- Processes, completes and resolves claim issues found in the Front Desk Claim inbox
- Maintains a current knowledge of insurance carrier rules and regulations, i.e., referrals, co-payments, etc
- Research complicated insurance issues in order to resolve them for clean claim creation
- Acts as a liaison with the insurance carriers, departments, and patients
- Acts as a resource for front office staff throughout the day by answering insurance questions
- Creates timely claims for all TCC (The Corvallis Clinic) departments
- a. Submission of timely and accurate claims to ensure TCC is capturing the highest potential revenue for each department
- b. Timely and accurate claim creation will drive revenue and will assist in meeting organizational monthly goals
- c. Reviews, edits, and creates claims that are "difficult" or in a "hold status" to ensure proper billing
- Engages in continuing education and self-evaluation to remain a knowledgeable specialist. This includes attendance and participation in department meetings; and remaining current on department policies and procedures
- Participates in orientation and training of new employees; focusing on insurance basics required for MOS on the front desk
- Communicates with providers regarding outstanding encounters that need to bill out as claims
- Works as a team with the other insurance and claim specialists in order to broaden knowledge and resolves issues as efficiently as possible
- Continually trains staff on insurance claims and authorization
- Ensures the authorization, claims, and preregistration hotline is always supported and answered when front office support is needed
- One (1) or more years of experience in a medical office with knowledge of insurance and claims, required
- Candidates are required to successfully pass a pre-employment insurance assessment as part of the selection process
- One (1) or more years of experience in the customer service field, preferred
- Basic computer skills including MS Word and Excel
- Knowledge of medical terminology and understanding of insurance carriers
- Ability to work well with providers and other staff
- Ability to work on multiple tasks simultaneously in a busy, fast-paced environment while maintaining quality of work
- Work-life balance is a top priority at TheCorvallis Clinic
- 7 holidays + 2 floating holidays = 9 Paid Holidays Early release on ChristmasEve and New Year's Eve
- Generous Personal Leave Accrual
- Benefits: Medical w/ HSA or HRA, Dental,Flexible Spending Acct (FSA)
- Employer contribution to HSA and HRA (whenenrolled in Medical Plan)
- Employer paid Long Term Disability (LTD), BasicLife/AD&D, Employee Assistance Program (EAP)
- Voluntary Benefits (Vision, Life Insurance andAD&D, Pet Insurance, Aflac, Legal Shield)
- Retirement - 401k eligible and auto enrolledafter 90 days, 100% vested from day 1, with discretionary clinic match after 1year (w/hours requirement) and discretionary Profit Share after 2 years(w/hours requirement)
- Pay on Demand (up to 2x per month)
- Casual Fridays (with clinic approved attire)
- Year-round employee engagement events andfestivities
- Team centered culture, delivering exceptionalmedical care with compassion and a commitment to service
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Insurance and Claims Specialist - Corvallis, United States - Clinical Operations - The Corvallis Clinic Aumann Building
Description
Compensation: $ $22.05 per hour (based on years of experience)Summary:
The responsibility of the Insurance and Claims Specialist is to ensure accurate claim processing by being the primary source for creating, verifying, and updating current insurance for all Corvallis Clinic departments. This will require maintaining a current knowledge of insurance carrier rules and regulations, current coordination of benefits rules, and being a liaison between the insurance carriers and Clinic departments and patients. The Insurance and Claims Specialist will also aid in claims creation for all departments.
Principal Responsibilities:
