Insurance Specialist I (NAVA)

Base Pay Range:

Job Description:

The Insurance Specialist is a remote position working Monday-Friday. Training hours are 8am-5pm Monday-Friday PST. Hours may vary after training. Rate of pay will depend on experience and location of remote worker.

Summary: Address large volumes of unpaid or incorrectly paid claims to secure reimbursement.

General Description: Performs medical billing functions to third party claims. Reviews unpaid claims and denials and appropriately rebills the claim. Researches and/or resolves patient complaints. Researches and resolves credit balances, refunding appropriate party as needed. Tracks and monitors denials for trending and establishes plan of action to resolve systemic payer issues.

Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Reviews unpaid claims by calling for payment status, appealing denials and correcting and resubmitting claims when necessary.
• Follows up with insurance companies for any unpaid or incorrect paid services provided to patients.
• Helps patients understand how insurance companies process their billing claim.
• Helps patients with collection 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.
• Reviews appropriateness and process refunds for all payers as appropriate.
• Works with vendors to resolve payer issues.
• Corrects posting discrepancies to reflect payor’s adjudication advice.
• Researches payments received but not yet posted.
• Coordinates with credentialing liaison on provider enrollment issues.
• Attends monthly meeting to stay up to date with new policies and upcoming changes and communicate to leadership.
• Works closely with referring physician offices to obtain retroactive authorizations or referral numbers.
• Calls client on group bills for overdue accounts, provides information upon request and serves as liaison with leadership on charge discrepancies.
• Trains with peers and performs peer to peer QA.
• Supports the LLC Staff to provide eligibility status for patients on site.
• Other special projects and duties as assigned.

General Duties and 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.
• Valid state driver’s license and proof of insurance.
• 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.
• Rotates to other shifts and locations as needed.
• Performs other special projects and duties as assigned.

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 medical billing course is desired
• Experience: Patient accounts billing experience is desired
  • Working knowledge of Medinformatix or other patient accounting systems preferred
  • CPT and ICD-10 coding experience preferred
  • Good customer services skills
• Licensure: N/A
• Certifications: N/A
• Computer Skills: Experience with the following computer applications is highly desired: Microsoft Office products (Outlook, Word, Excel), Workday, Internet, Intranet, Meditech, Code Correct, Medinformatix, 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 Navani Health Services 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