Insurance Claims Specialist

NATURE OF DUTIES

Works in the billing office as an Insurance Claims Specialist.

SPECIFIC DUTIES

Work Insurance collections accounts as received, correcting and refilling claims as needed, or posting the necessary adjustments daily. Work mail including refund requests, extensions, and requests for additional information daily. Keep current on Insurance, Managed Care, and other changes including CPT and ICD coding, global, and CCI guidelines by reading provider newsletters, talking to provider representatives, etc. Answer patient questions concerning insurance or billing issues. Work follow-ups on a regular basis. Prepare and work outstanding reports. Prepare and work credit balance report. Maintain log of audits, including pre-payment audits. Performs other related duties as assigned and serves in whatever other capacity deemed necessary for successful completion of the mission and goals of CIS and in concordance with its patient philosophy.

STANDARDS OF PERFORMANCE

Maintain acceptable A/R levels for Private Insurance (Under 75 days in A/R). Maintain proper documentation (as outlined in the denial tracking handout) and keep follow-ups current. Keeps work area neat and organized. Helping fellow employees when all duties are complete Communicate any problems or difficulties concerning job duties as they arise to supervisor. Meets all deadlines and timeframes for completion of assignments. Performs all duties without significant error occurring with any regularity. Represents CIS in a professional manner at all times. Exhibits at all times good communication skills with physicians, patients, supervisors, and co-workers. Exhibits whenever possible a harmonious relationship with other CIS employees in order to accomplish the duties and responsibilities of the position. While perfect harmonious relationships with all employees is sometimes not achievable, not more than an occasional complaint should be received by the supervisor about the incumbent of this position. Adheres to the CIS Compliance Plan as it pertains to the above specific job duties. Uses best efforts to maintain compliance by following the CIS Corporate Compliance Plan, attending CIS compliance education, following medical documentation guidelines, and communicating concerns regarding compliance issues.

QUALIFICATIONS FOR THE POSITION

High School graduate preferred Demonstrated ability to organize Possess time management skills Ability to understand and use a computer system Experience with telephone collections preferred, but not required.