CARTI
Join to apply for the Insurance Specialist role at CARTI
2 days ago Be among the first 25 applicants
Join to apply for the Insurance Specialist role at CARTI
Brief Description
- Contacting insurance companies when necessary to follow up on denials, unpaid or partially paid claims, to pre-certify services or other issues as they arise and documenting on the patient account per established policies.
- Contacting patients when necessary to obtain current insurance information and ensuring that the information is correctly entered into their account, documenting on the account per established policies.
- Following up on unpaid claims through the Billing System.
- Taking phone calls from customers (Patients/guarantors, clinical staff, payors etc.) and answering questions about their accounts while maintaining HIPAA guidelines.
- Contacting clinical staff and/or patients when necessary to obtain information needed in order to resolve an issue on an account.
- Requesting correct/updated insurance information from patients so that charges may be billed to the correct insurance company, and following up to ensure that : the information was received and correctly entered on the account; the incorrect charges were refunded if already paid and generate corrected claim forms to the correct insurance company; the charges were paid.
- Discussing with the Business Services Manager those charges that need to be written off due to timely filing and other issues
- Bringing reimbursement issues to the attention of the Business Services Manager
- Change in reimbursement for a particular code
- Denial for out-of-network
- Bundling/unbundling of CPT codes
- Denial of services that should have, and normally would have, been paid
- Decrease in volume and/or dollar amounts of remits
- Partially paid claims
- Notifying the Patient Service Department when payments are received for bad debt balances.
- Ensure compliance with regulatory standards.
- Adhere to Administrative and departmental policies.
JOB SUMMARY: The primary responsibilities of the Insurance Specialist are: ensure that payments received from the insurance companies are posted correctly to the patient accounts; ensure that denials and unpaid or partially paid claims are thoroughly researched; to provide specialized assistance to our patients and clinical staff using their knowledge base of a particular insurance; to provide excellent patient service.
- Posting insurance payments using established procedures.
- Contacting insurance companies when necessary to follow up on denials, unpaid or partially paid claims, to pre-certify services or other issues as they arise and documenting on the patient account per established policies.
- Contacting patients when necessary to obtain current insurance information and ensuring that the information is correctly entered into their account, documenting on the account per established policies.
- Following up on unpaid claims through the Billing System.
- Taking phone calls from customers (Patients/guarantors, clinical staff, payors etc.) and answering questions about their accounts while maintaining HIPAA guidelines.
- Contacting clinical staff and/or patients when necessary to obtain information needed in order to resolve an issue on an account.
- Requesting correct/updated insurance information from patients so that charges may be billed to the correct insurance company, and following up to ensure that : the information was received and correctly entered on the account; the incorrect charges were refunded if already paid and generate corrected claim forms to the correct insurance company; the charges were paid.
- Discussing with the Business Services Manager those charges that need to be written off due to timely filing and other issues
- Bringing reimbursement issues to the attention of the Business Services Manager
- Change in reimbursement for a particular code
- Denial for out-of-network
- Bundling/unbundling of CPT codes
- Denial of services that should have, and normally would have, been paid
- Decrease in volume and/or dollar amounts of remits
- Partially paid claims
- Notifying the Patient Service Department when payments are received for bad debt balances.
- Ensure compliance with regulatory standards.
- Adhere to Administrative and departmental policies.
EXPERIENCE, KNOWLEDGE, SKILLS And ABILITIES
- Minimum of two years of medical office billing experience
- Knowledge of clinic policies and procedures
- Knowledge of medical terminology and insurance practices
- Knowledge of computer programs and applications
- Knowledge of grammar, spelling, and punctuation to type correspondence
- Skilled in gathering, interpreting, and reporting insurance information
- Skilled in trouble-shooting insurance problems and claims
- Ability to identify claim problems and recommend solutions
- Ability to sort and file insurance forms and associated information
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Ability to interpret a variety of instructions furnished in written, oral, or schedule form.
- Must interact and communicate both verbally and in written form.
- Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- While performing the duties of this job, the employee is regularly required to talk or hear.
- The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- Specific vision abilities required by this job include close vision and the ability to adjust focus.
The work environment described here are representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.
Comments
This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Seniority level
Seniority level
Entry level
Employment type
Employment type
Full-time
Job function
Job function
Other-
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at CARTI by 2x
Get notified about new Insurance Specialist jobs in Little Rock, AR .
Future Opening: Insurance and Financial Services Position - State Farm Agent Team Member
Little Rock, AR $55,000.00-$90,000.00 1 month ago
Insurance Professional (Leadership Trajectory)
Billing/Insurance Account Specialist - Little Rock, AR
Work-at-Home Inbound P&C Insurance Agent (Licensed)
Account Associate - State Farm Agent Team Member
Jacksonville, AR $35,000.00-$50,000.00 3 months ago
Field Claims Specialist II, Property (Little Rock, AR)-$2500 Sign on Bonus
Work-at-Home Inbound Insurance Agent (Paid Training & Licensing)
Remote Insurance Customer Service Representative (Unlicensed)
Future Opening: Insurance Account Representative - State Farm Agent Team Member
Bryant, AR $30,000.00-$40,000.00 2 years ago
Account Associate - State Farm Agent Team Member
Jacksonville, AR $35,000.00-$50,000.00 4 months ago
Insurance Account Position - State Farm Agent Team Member
Bryant, AR $40,000.00-$60,000.00 2 years ago
Licensed Life and Health Insurance Specialist
Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr