Reimbursement Specialist - Insurance Verification (UTMC Program)

Helen Ross McNabb Center; Knoxville (TN); On-site; USD 22,000 - 32,000; Full time

Job summary

Helen Ross McNabb Center in Knoxville, TN is seeking a Reimbursement Specialist - Insurance Verification (UTMC Program). The role focuses on verifying client commercial insurance coverage and ensuring procedures are billed correctly.

You will enter data into the billing system and resolve insurance discrepancies to support timely payments. The position requires strong Excel/Outlook skills, attention to detail, and the ability to work with multiple departments to resolve issues while maintaining

Qualifications

• Advanced use of computer system software, Excel, Outlook and Microsoft Word.
• Knowledge of insurance guidelines for Commercial, Medicare, TennCare, Federal Medicaid and Private Pay financial classes.
• Exceptional customer service skills for interacting with patients regarding medical claims and payments.
• Ability to work well in a team environment and alone.
• Strong written and verbal communication skills.
• Maintain patient confidentiality as per HIPAA.

Responsibilities

• Verify and update client insurance information.
• Enter data accurately in billing system and update client benefit information.
• Audit and resolve insurance issues and communicate with team leader.
• Maintain HIPAA compliant records and prepare reports as needed.
• Assist in determining proper courses of action for insurance verifications and billing follow-up.

Skills

Customer service

Communication

Teamwork

Prioritization

Education

High school diploma or equivalent

Tools

Excel

Outlook

Word

Job description

Help Others, Make a Difference, Save a Life.

Do you want to make a difference in people's lives every day?

Or help people navigate the tough spots in their life?

And do it all while working where your hard work is appreciated?

You have a lot of choices in where you work...make the decision to work where you are valued!

Join the McNabb Center Team as the Reimbursement Specialist - Insurance Verification (UTMC Program) today!

The Reimbursement Specialist - Insurance Verification (UTMC Program)

Job Summary

• The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance.
• Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate.
• The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions.
• Will be required to work regular office hours at the designated facility.

Job Description

• Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information.

Job Duties/Responsibilities

• NOTE: The job duties listed are typical duties of the work performed. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty.
• Reviews the center's Commercial Notification Forms and returns an Insurance Verification Forms to the requesting staff within designated program timeframe.
• Verifies insurance information is up to date for the next day's client roster and updates any applicable pop-ups in the system
• For new clients, gives contact information, obtain client photo, updates the EMR with correct information and ensures the appropriate intake packet paperwork has been signed and verified to ensure clients understanding of policies.
• Prepares and updates the designated facility facesheets with insurance issues, patient responsibilities, outstanding balances, and any non-payment status changes for the next day and places them in HIPAA compliant blue folders for the appropriate providers.
• Analyzes designated eligibility reports on a daily basis.
• Communicates with and advises Insurance Verification Team Leader of all problems related to insurance verification.
• Advises other departments of updated or new insurance information as needed.
• Adheres to all policies and procedures related to compliance with all federal and state billing regulations.
• Communicates with billing representatives regarding any insurance issues that may arise.
• Review and update the Non-Payment status documents for both Med appointments and Therapy appointments
• Maintains a positive and professional attitude.
• Reads all emails and responds accordingly in a timely manner.
• Listens to all voicemails and responds accordingly in a timely manner.
• Works with members of various teams and/or departments on identifying process improvements.
• Possess flexibility to work overtime as dictated by department/organization needs.
• Communicates with clients regarding any benefit and/or billing questions they may have.
• Performs specified client benefit duties to ensure all required information is obtained for insurance verification, billing, and claims follow-up.
• Collects all client responsibility balances via cash, check, money order or credit card and issues receipts for payments.
• Assists in determining proper courses of action for successful resolution to insurance issues.
• Completes all program related paperwork required for reporting purposes.
• Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Reviews patient bills for accuracy and completeness and obtains any missing information.
• Sets up patient payment plans and works collection accounts.
• Submits monthly recommendations to supervisor for write-offs with complete documentation by first of the following month all while following the A/R Reference Guide on how to complete write offs.
• Performs additional duties as requested by Team Leads or Management Team.

This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment.

Job Qualifications

• Advanced use of computer system software, Excel, Outlook and Microsoft (word processing and spreadsheet application).
• Knowledge of insurance guidelines for all Commercial, Medicare, Medicare Advantage, TennCare, Federal Medicaid and Private Pay financial classes.
• Exceptional customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Ability to work well in a team environment and alone.
• Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems.
• Strong written and verbal communication skills.
• Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Maintain a good understanding of the state, federal, and payer guidelines on billings, collections, refunds, and overpayments.
• Knowledge of the center's Policies and Procedures.
• Ability to maintain records and prepare reports and correspondence related to the position.
• Ability to work directly with upper leadership regarding claims issues and resolutions.
• Possess effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others.

Compensation

• Starting salary for this position is approximately $19.54/hr based on relevant experience and education.

Schedule

• Monday - Friday 8am - 5pm

Travel

• N/A

Equipment/Technical Competency

• Advanced use of computer system software, Excel, Outlook and Microsoft (word processing and spreadsheet application).

QUALIFICATIONS - Reimbursement Specialist - Insurance Verification (UTMC Program)

• Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties.

Education / License

• High school diploma or equivalent required.

Location

• Knox County, Tennessee

Compensation details

19.54-19.54 Hourly Wage

Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.

Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply.