Insurance Follow-up Specialist

Tryon Medical Partners; Charlotte (NC); On-site; USD 48,000 - 66,000; Full time

Job summary

Tryon Medical Partners is seeking a Revenue Cycle- Account Reimbursement Specialist II to join the RCM team in Charlotte. The role focuses on accurate billing for office and hospital procedures, ensuring HIPAA compliance and timely claim processing.

Responsibilities include daily billing, eligibility checks, claim corrections, and communicating with payers. Requires 2+ years in complex claim follow-up, EMR experience (AthenaHealth a plus), and strong attention to detail.

Qualifications

• Minimum of two (2) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
• Knowledge of medical terminology, ICD-10, and CPT codes.
• Excellent computer skills; Intermediate skill with Microsoft Word, Outlook, and Excel.
• Experience working within EMR systems; AthenaHealth EMR is a plus.
• Experience interpreting payor explanation of benefits.
• Excellent verbal communication skills and strong customer-service background.
• Ability to manage time and organize daily schedule to meet productivity and accuracy standards.

Responsibilities

• Performs daily billing activities to ensure successful processing and payment of claims.
• Ensures claim information is complete and accurate for charge entry and data enters key demographic information necessary for insurance claim processing.
• Verifies all patient benefits, eligibility, and coverage to ensure accurate billing.
• Audits completeness and accuracy of all claims prior to submission to claims clearinghouse.
• Make necessary claim corrections to resolve payer claim edits and rejections.
• Reports billing changes, billing issues, and process improvement plan accomplishments to RCM Leadership.
• Completes tasks in RCM to resolve patient cases (via phone or written communication), process virtual payments, process insurance refund requests, research missing payments, process bankruptcy and deceased patient notifications, and collection account reconciliation.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Skills

Medical terminology

ICD-10 knowledge

CPT coding

EMR systems

AthenaHealth EMR

Microsoft Word

Outlook and Excel

Communication skills

Education

High school diploma or equivalent

Associate degree in business, healthcare administration or related field

Tools

AthenaHealth EMR

Job description

Revenue Cycle- Account Reimbursement Specialist II

Job Summary:

The Account Reimbursement Specialist I (ARS I) is responsible for accurately processing information to ensure accurate and compliant billing for office and hospital procedures. The Revenue Cycle – ARS I researches insurance guidelines and focuses on improving the effectiveness of billing processes. The position requires attention to detail, strong organizational skills, and dependability. This role is vital to the overall financial success for the organization. (This is a full time position that will support our RCM team at SouthPark Monday to Friday, 8 am to 5 pm)

Primary Job Responsibilities:

• Performs daily billing activities to ensure successful processing and payment of claims.
• Ensures claim information is complete and accurate for charge entry and data enters key demographic information necessary for insurance claim processing.
• Verifies all patient benefits, eligibility, and coverage to ensure accurate billing.
• Audits completeness and accuracy of all claims prior to submission to claims clearinghouse.
• Make necessary claim corrections to resolve payer claim edits and rejections.
• Reports billing changes, billing issues, and process improvement plan accomplishments to RCM Leadership.
• Completes tasks in RCM to resolve patient cases (via phone or written communication), process virtual payments, process insurance refund requests, research missing payments, process bankruptcy and deceased patient notifications, and collection account reconciliation.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Requirements:

• Minimum of two (2) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
• Knowledge of medical terminology, ICD-10, and CPT codes.
• Excellent computer skills; Intermediate skill with Microsoft Word, Outlook, and Excel.
• Experience working within EMR systems. Experience with AthenaHealth EMR is a plus.
• Experience interpreting payor explanation of benefits.
• Excellent verbal communication skills and strong customer-service background.
• Ability to manage time and organize daily schedule to meet productivity and accuracy standards.

Education and Certifications:

• High school diploma or equivalent required.
• Associate degree in business, healthcare administration or related field highly preferred.

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.