Insurance Specialist

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

JOB SUMMARY:

The Insurance Specialist is responsible for review and resolution of outstanding insurance balances on hospital or physician patient accounts. The Insurance Specialist will be required to have flexibility to learning and comprehending complex hospital systems and keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client and federal guidelines

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Effectively manages assigned insurance receivables to achieve business line expectations
• Meets productivity standards as outlined by business line
• Achieves a minimum of 85% work quality scoring and accuracy on all accounts worked
• Completes timely follow-up on assigned accounts to ensure no cash loss
• Meets monthly cash expectations as set out for assigned client receivables
• Ensures insurance accounts are resolved within 90 days of placement
• Demonstrates the ability to prioritize work with some oversight to meet outlined goals
• Perform account research and route accounts through appropriate client workflows
• Ability to understand, navigate and perform research of account within client host systems
• Exceptional understanding of patient accounting systems allowing for ease of transition and learning of new systems as needed by business line
• Clearly documents actions taken and next steps for account resolution in patient accounting system
• Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system
• Appropriately makes requests for documentation based on account needs and compliance guidelines
• Ability to navigate billing system to perform basic claim billing functions
• Clearly prepares appeals for payment to insurance company when appropriate
• Ensure strong communication skills to convey intricate account information
• Ensure all accounts are worked within client standards and Federal Regulations
• Maintain high quality account handling per client standards
• Work within federal, state regulations, department/division & all Compliance Policies
• Maintain clear, concise, and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications
• Maintain continuing education, training in industry career development
• Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
• Attends training sessions as directed by management
• Integrate information obtained through training sessions and policy changes immediately into daily routine

MINIMUM QUALIFICATIONS & REQUIREMENTS:

• 1 year of experience in a health care receivables environment
• High School Diploma
• Excellent oral and written communication skills, basic computer skills, familiarity with widely used patient accounting software
• Data management skills, attention to detail and accuracy, good problem-solving skills
• Ability