Billing Specialist II (NAVA)

Base Pay Range:

Job Description:

The Insurance Specialist is a Full Time, Regular position working remote Monday-Friday

Summary: Responsible for addressing large volumes of unpaid or incorrectly paid claims to secure accurate and timely reimbursement. The Billing Specialist II performs advanced claim follow-up, denial resolution and payer issue management with a high degree of accuracy and independence.

General Description: The Billing Specialist II performs complex medical billing functions related to third-party claims. This includes reviewing unpaid claims and denials, rebilling as needed, analyzing payer trends, resolving credit balances, researching patient claim concerns and coordinating solutions for systemic payer issues. This role requires a minimum of one (1) year of insurance, billing or claims experience in a healthcare setting.

Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Reviews unpaid claims by calling for payment status, submitting appeals, and correcting / resubmitting claims when necessary.
• Follows up with insurance companies for any unpaid or incorrectly paid services.
• Assists patients with insurance questions when Collections Specialist is not available.
• Writes off uncollectible balances with dollar values as high as $500 (dependent on experience).
• Resolves claim edits (missing claim information) prior to the submission of the claim to insurance companies.
• Works with vendors to resolve payer issues.
• Corrects posting discrepancies to align with payer adjudication.
• Researches payments received but not yet posted.
• Coordinates with credentialing liaison to address provider enrollment issues.
• Attends monthly meetings to stay updated on policies, upcoming changes and communicates relevant information to leadership.
• Works with referring physician offices to obtain retroactive authorizations or referral numbers.
• Contacts clients regarding overdue accounts, provides requested information and communicates charge discrepancies to leadership.
• Participates in peer-to-peer training and quality assurance activities.
• Supports the LLC staff with onsite eligibility inquiries as needed.
• Performs special projects and additional duties as assigned.

Internal Promotion Pathway to Level II

Current Navani employees may be promoted from Billing Specialist I to Billing Specialist II upon meeting all of the following:

• Completion of one (1) full year of continuous service at Navani as an Billing Specialist I
• Consistently meeting or exceeding performance metrics and quality benchmarks for at least six (6) consecutive months.
• Demonstrated ability to manage complex claims, denials, payer follow-up, and problem solving with minimal supervision
• Demonstrated good attendance, meeting departmental standards and maintaining reliability in schedule adherence.
• Recommendation of leadership

(Promotion is not automatic; final approval is at management discretion)

General Duties/Responsibilities:

• Ability to maintain strict confidentiality within the Inland Imaging companies and Inland’s customers.
• Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.
• Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.
• Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.
• Honest, pleasant manner and good personal hygiene.
• Free of alcohol and drug abuse.
• Ability to access multiple worksites in a timely manner.
• Excellent communication and interpersonal skills.
• Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
• Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
• Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.

• Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
• Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
• Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.
• Quarterly quality assurance meeting attendance is required for this position.
• Attendance is a requirement for this position.
• Requires flexibility with scheduled work hours the final week of the month/year to ensure all available dollars are posted to client A/R system by close of business.

Supervisory Responsibilities:

• There is little or no supervisory responsibility in this position.

Advocacy:

Treats all clients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values:

• Show We Care, Do The Right Thing, Maximize Individual Potential, Challenge Convention

Qualifications:

• Education: High School Diploma/GED required
  • Two years of medical billing course preferred
• Experience:
  • Minimum of one (1) year in medical experience in medical billing, insurance follow-up, claims processing or related patient accounts work required.
  • Working knowledge of Imagine Software or other patient accounting systems preferred
  • CPT and ICD-10 coding experience preferred
  • Strong customer services skills required
• Licensure: N/A
• Certifications: N/A
• Computer Skills: Experience with the following computer applications is highly desired: Microsoft Office Suite (Outlook, Word, Excel), Workday, Webex, Internet/Intranet, Meditech, Code Correct, Medinformatix, Imagine, PhiCure, Waystar.
• Background Check:
  • Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
  • In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG). Employees must not be included on this list.
• Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test.

Nuvodia/Inland is an EEO employer...

Originally posted on Himalayas