Insurance AR Specialist -Remote -TX Resident (2247)

Ortholonestar; Houston (TX); Hybrid; USD 38,000 - 54,000; Full time

Job summary

ORTHOLONESTAR is seeking a claims reviewer to review and submit insurance claims on a daily basis in a climate-controlled office. You will prepare and submit clean claims to various insurance companies electronically or on paper and contact carriers for claim status.

The role requires a High School Diploma or GED and at least one year of medical billing/collections experience, with strong attention to detail, numerical ability, and familiarity with HIPAA requirements.

Qualifications

• High School Diploma or GED, and minimum one year experience in a medical billing/collections field.
• Ability to write and read.
• Math ability: add, subtract, multiply and divide with accuracy.
• Reasoning ability to interpret explanations of benefits to identify denial reasons.
• Basic proficiency in Microsoft Outlook/Office; ability to learn new software.

Responsibilities

• Prepares and submit clean claims to various insurance companies electronically or on paper.
• Contact carriers by phone or website for claim status on outstanding balances.
• Process and work all insurance correspondence.
• Perform collection actions including contacting patients by phone and resubmitting claims.
• Obtain documentation required to submit to insurance to expedite payments.
• Answer questions from patients, clerical staff and insurance companies.
• Identify and resolve patient billing complaints.
• Prepare appeal letters for denied claims and document collection activities.
• Identify underpayments by checking payments against contracted fee schedule.
• Work and process all insurance refund requests.
• Report payer issues or delays to supervisor.

Skills

Typing 45 WPM

Microsoft Office proficiency

HIPAA awareness

Education

High School Diploma or GED

Job description

Job Summary: Responsible for reviewing and submitting claims on a daily basis.

Essential Duties and Responsibilities: The essential duties of the position include the following. Other duties may be assigned.

Key Functions:

• Prepares and submit clean claims to various insurance companies either electronically or on paper.
• Contact carriers by phone or website for claim status on outstanding insurance balances.
• Process and work all insurance correspondence.
• Perform various collection actions including contacting patients by phone, correct and resubmitting claims to other carriers.
• Obtain necessary documentation required to submit to insurance to expedite payments.
• Answers questions from patients, clerical staff and insurance companies.
• Identify and resolve patient billing complaints.
• Prepare appeal letters for all claims that are denied for payment.
• Document all collection activities using guidelines in place.
• Identify underpayments by checking payments received against our contracted fee schedule.
• Work and process all insurance refund requests.
• Report payer issues or delays to supervisor.
• Participate in educational activities
• Maintains strict confidentiality; adhere to all HIPAA guidelines/regulations.
• Team Player with ability to solve problems and recommend solutions.
• Must be able to manage assigned workload and prioritize accordingly.
• Maintain accurate and timely reconciliation of accounts receivable.
• Review claims stopped in the claim scrubber.
• Work Claims rejected by the clearinghouse.

Supervisory Responsibilities: None.

Qualifications

Qualifications: 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.

Education/Experience: High School Diploma or GED, and minimum one year experience in a medical billing/collections field.

Language Ability: Ability to write and read

Math Ability: Ability to add, subtract, multiple and divide on all units of measure, using whole numbers, common fractions and decimals .

Reasoning Ability: Ability to read and interpret explanation of benefits remittances to determine and identify claim denial reasons and necessary course of action for resolutions.

Computer Skills: Ability to type 45 WPM, basic proficiency in Microsoft Outlook/Office, and experience using or ability to learn and comprehend computer programs.

Certificates and Licenses: None

Work Environment : Position works in a climate-controlled office environment in a cubicle setting.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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