Insurance Reviewer II

Springfield Clinic; Illinois; In loco; USD 52.000 - 68.000; Tempo pieno

Descrizione del lavoro

Springfield Clinic is seeking an Insurance Reviewer II to manage payer communications, update patient registrations, and process insurance vouchers and adjustments. You will work with primary and secondary billing, analyze claims, and respond to audits in a fast-paced medical office environment.

The role requires a high school diploma or GED and prior medical billing office experience, with preferred knowledge of CPT/ICD-9 coding. Office setting, standard hours, HIPAA training expected.

Competenze

• Working knowledge of medical terminology preferred.
• Working knowledge of CPT and ICD-9 coding preferred.

Mansioni

• Handle all phone calls and messages in designated insurance area.
• Update registration screens as requested or as necessary.
• Review and process insurance vouchers, rebilling charges not paid, and processing adjustments.
• Process secondary billing as requested by patients or defined by procedure.
• Distribute incoming insurance mail and respond to audits, inquiries, and requests.
• Process corrections/adjustments to correct patient invoices.
• Process designated insurance reviews to obtain additional payments on claims.

Conoscenze

Medical terminology

CPT/ICD-9 coding

Formazione

High School diploma or GED

Descrizione del lavoro

Job Description

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment from third-party payors and reporting to management on observed trends and issues.

Job Relationships

Reports to the Insurance Review Supervisor

Principal Responsibilities

• Handle all phone calls and messages received specific to designated insurance area.
• Update registration screens when requested by patients or as necessary.
• Review and process all designated insurance vouchers received, rebilling charges not paid and processing adjustments as needed utilizing websites or telephone as necessary.
• Process all secondary billing as requested by patients or defined by procedure.
• Distribute incoming insurance mail received and respond to all audits, inquiries and additional information requests.
• Process corrections/adjustments as necessary to correct the patient's invoice.
• Process designated insurance reviews when requested to obtain additional payments on claims utilizing websites or telephone as necessary.
• Analyze and process front-end system edits for correct physician productivity and billing of claims.
• Analyze and process back-end system edits for correct registration and billing of claims.
• Analyze and process claims denied through clearinghouse.
• Investigate and process claims in the insurance work files and/or on the insurance reports.
• Must report all incidents to immediate Supervisor or Manager.
• Assist with special projects and assignments as directed.
• Must attend in-services and training relevant to position.

Perform Other Job Duties As Assigned.

• Confidentiality required.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to SC Way customer service philosophy.

Education/Experience

• High School graduate or GED required.
• Previous Experience In a Medical Billing Office Required.

Knowledge, Skills and Abilities

• Working knowledge of medical terminology preferred.
• Working knowledge of CPT and ICD-9 coding preferred.

Computer, Typing And Calculator Skills Required.

• Must be able to work individually or on a team.

Working Environment

Office environment, sitting for long periods

PHI/Privacy Level

HIPAA1