Insurance Specialist - CPAR Required - 8 AM - 4:30 PM Eastern

Northeast Georgia Medical Center; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Northeast Georgia Health System (NGHS) seeks an Insurance Specialist to serve as the primary contact for patient questions related to insurance claims, denials, coding, re-determinations, settlements, and retro authorizations.

The role handles credit balances and pay discrepancies, reviews prior billing activity, and acts as a subject matter expert on payer guidelines to improve underpayment recovery and claim adjudication.

Qualifications

• CPAR and CPB or CPC certification; CPB or CPC can be obtained within one year of hire.
• High School Diploma or GED.
• Minimum 3 years of medical billing and/or medical coding experience.

Responsibilities

• Verifies and updates patient insurance coverage and rebills claims as appropriate.
• Resolves patient inquiries by phone and electronic messages; deescalates complaints.
• Researches and resolves billing issues with payers and patients; reviews EOBs for accuracy.
• Maintains understanding of HIPAA regulations and patient privacy.
• Supports department to meet quality and productivity standards.
• Liaises with patients and payers to resolve insurance billing issues.

Skills

Customer service

Communication

Computer skills

HIPAA knowledge

Independent work

Interpersonal skills

Education

High School Diploma or GED

Job description

Job Summary

The Insurance Specialist serves as a key contact for patient questions related to insurance claims, denials, coding, re-determinations, attorney settlements, and retro authorizations. The Insurance Specialist handles resolving credit balances and pay discrepancies, reviewing prior billing activity and correcting errors. The Insurance Specialist serves as a subject matter expert on payer guidelines, focusing on underpayment recovery, aged denial resolution, and supporting claim adjudication.

Minimum Job Qualifications

• Licensure or other certifications: Certified Patient Account Representative (CPAR) and Certified Professional Biller (CPB) or Certified Professional Coder (CPC). CPB or CPC can be obtained within one year of hire.
• Educational Requirements: High School Diploma or GED.
• Minimum Experience: Minimum 3 years of medical billing and/or medical coding experience.

Job Specific and Unique Knowledge, Skills and Abilities

• Knowledge of Revenue Cycle functions, including registration, coding/charge posting, payment posting, and financial assistance.
• Thorough knowledge of patient collections, billing regulations (governmental and commercial), denial follow-up procedures, and interpreting EOBs to resolve posting and billing issues.
• Personal computer proficiency to include all programs necessary to perform job duties and ability to toggle between systems efficiently.
• Strong listening, problem-solving, and customer service skills with the ability to remain calm and professional in stressful situations
• Excellent verbal and written communication skills with strong telephone proficiency.
• Ability to work independently within guidelines.
• Thorough knowledge of HIPAA regulations to protect patient health information.

Essential Tasks and Responsibilities

• Verifies and updates patient insurance coverage. Rebills claims as appropriate. Reviews and updates patient accounts and insurance coverage, rebilling claims as appropriate.
• Meets or exceeds required quality, and productivity performance standards as determined by SPRC leadership.
• Follows scripting and departmental guidelines to ensure quality service
• Researches and resolves patient inquires via phone and electronic messages, deescalating complaints to improve the billing experience, and escalating to leadership when appropriate
• Attends all Weekly/Monthly/Quarterly/Annual department and Department Meetings.
• Works with patient/guarantor to find/add insurance, third-party sponsorship, and settlement.
• Maintains an understanding of health insurance and EOB's, collection processes and techniques, and NGHS Financial Assistance Programs.
• Adapts to frequently changing atmosphere including organizational and technological changes.
• Performs other duties as assigned, including but not limited to work queues, itemized statement requests, providing Detail Bills, 1500s and Ubs
• Promotes and contributes positively to the teamwork of the department by assisting coworkers, contributing ideas and problem-solving with co-workers and helps identify trends affecting patient billing and customer satisfaction.
• Liaises with patients and payers to resolve insurance billing issues, obtain required documentation, and review EOBs for payment accuracy.
• Contacts insurance companies via telephone and websites to reprocess aged facility and professional claims.
• Identifies and corrects posting errors and underpayments or denials that are still within the appeal window, resubmitting claims for late charges and other issues.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
• Vision: Heavy, Constantly 66-100% of time
• Kneeling/Stooping/Bending: Occasionally 0-30%
• Standing/Walking: Occasionally 0-30%
• Pushing/Pulling: Occasionally 0-30%
• Intensity of Work: Constantly 66-100%
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.