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A healthcare organization in Georgia is seeking an Insurance Specialist to serve as a key contact for patient insurance questions. The role involves handling claims, denials, and ensuring accurate billing practices. Candidates should have a high school diploma or GED, along with relevant certifications and at least three years of experience in medical billing or coding. Strong communication and problem-solving skills are essential. This position offers opportunities for career growth within a supportive team environment.
Job Category: Revenue Cycle
Work Shift/Schedule: 8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
Posting Details
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.
Licensure or other certifications: Certified Patient Account Representative (CPAR) and Certified Professional Biller (CPB) or Certified Professional Coder (CPC)
Educational Requirements: High School Diploma or GED.
Minimum Experience: Minimum 3 years of medical billing and/or medical coding experience.
Other:
Preferred Licensure or other certifications:
Preferred Educational Requirements:
Preferred Experience:
Other:
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.
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.
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.