Insurance Reviewer II

Jobtailor; Springfield (IL); On-site; USD 42,000 - 56,000; Full time

Job summary

Springfield Clinic is seeking a Medical Billing Clerk to manage insurance claims and patient invoices within a HIPAA-compliant environment.

The role emphasizes accuracy in CPT/ICD-9 coding, attention to detail, and teamwork in a busy medical office setting in Springfield, IL.

Qualifications

• High School graduate or GED required.
• Previous experience in a medical billing office required.
• 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.
• Confidentiality required.
• HIPAA privacy level.
• Must attend in-services and training relevant to position.
• Adhere to OSHA and Springfield Clinic training & accomplishments as required per policy.

Responsibilities

• Complete assigned tasks involved in securing payment from third-party payors.
• Report observed trends and issues to management.
• Handle phone calls and messages for the designated insurance area.
• Update registration screens as requested or necessary.
• Review and process insurance vouchers, rebill unpaid charges, and process adjustments.
• Process secondary billing.
• Distribute incoming insurance mail and respond to audits, inquiries, and information requests.
• Correct patient invoices through corrections and adjustments.
• Conduct insurance reviews to obtain additional claim payments.
• Analyze and process front-end and back-end system edits for accurate productivity, registration, and billing.
• Analyze and process clearinghouse-denied claims.
• Investigate and process claims in insurance work files and reports.
• Report incidents to the immediate Supervisor or Manager.
• Assist with special projects and assignments.
• Perform other assigned duties.
• Provide excellent customer service and follow the SC Way customer service philosophy.
• Reports to the Insurance Review Supervisor.
• Work in an office environment, sitting for long periods.

Skills

Medical Billing

CPT Coding

ICD-9 Coding

Medical Terminology

Team Collaboration

Confidentiality

Problem Solving

Customer Service

HIPAA Compliance

Education

High School Diploma

GED

Tools

Office Software

Calculator

Job description

• Complete assigned tasks involved in securing payment from third-party payors
• Report observed trends and issues to management
• Handle phone calls and messages for the designated insurance area
• Update registration screens as requested or necessary
• Review and process insurance vouchers, rebill unpaid charges, and process adjustments
• Process secondary billing
• Distribute incoming insurance mail and respond to audits, inquiries, and information requests
• Correct patient invoices through corrections and adjustments
• Conduct insurance reviews to obtain additional claim payments
• Analyze and process front-end and back-end system edits for accurate productivity, registration, and billing
• Analyze and process clearinghouse-denied claims
• Investigate and process claims in insurance work files and reports
• Report incidents to the immediate Supervisor or Manager
• Assist with special projects and assignments
• Perform other assigned duties
• Provide excellent customer service and follow the SC Way customer service philosophy
• Reports to the Insurance Review Supervisor
• Work in an office environment, sitting for long periods

Requirements

• High School graduate or GED required
• Previous experience in a medical billing office required
• 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
• Confidentiality required
• HIPAA1 privacy level
• Must attend in-services and training relevant to position
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy

Core Competencies

Demonstrates expertise in medical billing processes, including insurance claim management, CPT and ICD-9 coding, and adherence to HIPAA regulations. Strong ability to analyze billing discrepancies and provide excellent customer service in a medical office environment.

Highest-signal resume keywords

• Medical Billing Experience
• CPT Coding
• ICD-9 Coding
• HIPAA Compliance
• Customer Service

Hard Skills

• Medical Terminology
• Insurance Claims Processing
• Data Entry
• Billing Adjustments
• Insurance Voucher Review

Soft Skills

• Team Collaboration
• Confidentiality
• Problem Solving

Certifications & Qualifications

• High School Diploma
• GED

Industry Keywords

• Third-Party Payors
• Insurance Audits
• OSHA Compliance
• Patient Invoicing
• Clearinghouse Claims

Tools & Technologies

• Office Software
• Calculator