Accounts Receivable Insurance Specialist

Job Purpose

The Accounts Receivable Insurance Specialist will validate insurance coverage and accurately submit all qualified accounts for insurance billing within the client system. The Accounts Receivable Insurance Specialist will conduct appropriate insurance follow up and verify claim adjudication for all accounts as needed.

Duties and Responsibilities

• Conduct detailed review at the account level to determine accuracy of insurance processing. Review EOB’s, plan coverage, previous billing history and calls insurance carriers when needed.
• Validate insurance via phone and internet to confirm eligibility for specific charges on specific dates of service
• Review client billing system to confirm charges were not previously billed or identify edits that need to be made prior to rebilling
• Work with insurance carriers and patients to resolve insurance related issues such as coordination of benefits, plan coverage limitations and line-item denials
• Work assigned inventory, work queues, reports, and across all Company product lines. Consistently meets internal and external deliverables with minimal involvement from management.
• Timely and courteous response to inbound communications (via telephone, e-mail, etc.) from patients, insurance carriers, internal or external clients regarding account status
• Identify/locate patient, insurance carrier or other third party that is liable for payment of account and initiates contact (via telephone, internet, etc.) to determine reason for non-payment, identify insurance options, and establish repayment arrangements
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• One year certificate from college or technical school; or three to six months related experience and/or training; or equivalent combination of education and experience
• 2-3 years job-related experience
• Working knowledge of insurance follow up processes required
• Must be proficient in reimbursement methodology
• Must be proficient in MS Office applications
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented 
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.