Insurance Billing Specialist

Title: Insurance Follow-Up/Payment Specialist

Reporting Relationship
:
Patient Financial Services Manager
General Summary of Responsibilities
:
With limited supervision, the insurance follow-up clerk is responsible for follow-up of Medicare, Medicaid, commercial insurance, MVA, 3 rd Party Liability, and Workmen's Comp claims. Effectively communicates with insurance billing specialist to ensure claims are followed up on in a timely manner. Effectively communicates via telephone with insurance customer service representatives. Uses the internet to navigate insurance company websites to check on claim status.

Builds a positive relationship with patients inquiring about claim status and payment. With limited supervision, process payments from Medicare, Medicaid, commercial insurance companies, workmen's comp, 3 rd party liability and motor vehicle accident insurance companies on a daily basis for data entry. Cross train with other positions to ensure a smooth workflow. Together with team members, communicate in a manner that builds positive patient relations.

Participates in monthly staff meetings and attends classes, workshops, seminars relating to billing/collections of accounts.

To verify insurance coverage, pre-certification and/or pre-authorization requirements for Inpatient, Outpatient Observation and outpatient services patients. To coordinate activities with the Utilization Review, Surgery and other departments to assure pre-certification requirements are met. All communications are conducted in a manner that will result in positive patient relations.
Essential

Job Responsibilities:

Insurance Follow-Up Specialist:

Submit secondary payer claims to appropriate insurance following up every 60 days or more often as necessary to track payments or problems.

Submit secondary payer claims within 5 days of receiving primary insurance explanation of benefits.

Follow through on Medicare, Medicaid, commercial insurance, VA, MVA, 3rd Party Liability, and Workmen’s comp claims identified as requiring action as a result of denials and/or no payment claims.

Create UB04 using Meditech system if needed to resubmit a claim followed up on.

Maintains Medicare, Medicaid, commercial insurance, VA, MVA, 3rd Party Liability, and Workmen’s Comp claims, 90 days and older at or below 15% of total claims outstanding.

Documents all follow up to claims in Meditech system.

Handles phone, mail, and personal inquiries from patients promptly, efficiently, and courteously.

Follows through on all issues identified requiring action as a result of inquiry.

Documents all phone and personal inquiries in Meditech system.

Manage Professional accounts including billing claims and following up in order to receive payment.

Participates in educational opportunities offered by the hospital for job and personal development.

Participates in monthly staff meetings and attends classes, workshops, seminars relating to billing/collections of accounts.

Other duties as assigned.

Payment Specialist:

Process Medicare, Medicaid, commercial insurance, workmen’s comp, 3rd party liability, and motor vehicle accident insurance payments for data entry.

Analyze Explanation of Benefits and make notation of whether account should be rolled to secondary payer.

Assign proper payment type on claims when no payment is being made and follow up with the appropriate insurance company.

Verify that admissions are in the correct financial class based upon which insurance company is making the payment.

Fill out cash receipt form for data processing to balance payments.

Documents detailed payment information in current computer system to clearly explain and easily track payment history.

Reconcile Medicare, Medicaid, commercial insurance, workmen’s comp, 3rd party liability, and…