Flagler Health+
Insurance Specialist II | Ambulatory Revenue Cycle | Full-time | Days
Flagler Health+, St. Augustine, Florida, United States
Overview
The Insurance Specialist II is responsible for follow up on new and outstanding accounts in a professional and consistent manner. Accurately document account statuses, notes, etc. in the AR management system. Maintains compliance with FDCPA, FCRA, HIPAA plus local, state and federal regulations. Demonstrates attention to detail, achieves the determined production and quality expectations and works well under pressure. Responsibilities
Responsible for claims processing and timely insurance follow up. Provide customer service to all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Provide exceptional customer service with all payers. Relay information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to management. Recognize trends in the aging reports and work with payers to decrease response/payment turnaround. Working knowledge of billing claims system. Review, understand, and work unpaid claim denials and rejections, make necessary corrections through worklists and reporting tools. Conduct eligibility and denial reviews. Respond promptly to all correspondence (fax, email, telephone, mail) and ensure timely filing deadlines are met where applicable. Initiate appeal requests per payer guidelines in a timely manner. Verify all demographic and insurance information in patient registration and provide feedback to front office staff to ensure accuracy and timely reimbursement. Ability to research, understand and educate on payer contracts when needed. Monitor various payers bulletins and educational updates to provide information to appropriate team members. All other duties as assigned by department. Qualifications
Education / Training
High School Diploma/Equivalent Experience Requirements
5 to 7 years Insurance Follow-up Denials, Appeals Preferences
Extensive working knowledge of insurance accounts receivable collections and claims follow up. Extensive working knowledge of Florida payer guidelines and insurance carrier payment rules. Ability to appeal claims based on extensive working knowledge of payer/claim issues. Familiarity with claim software and clearinghouse. Familiarity with both government and commercial insurance plans. Experience with denial and appeal process.
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The Insurance Specialist II is responsible for follow up on new and outstanding accounts in a professional and consistent manner. Accurately document account statuses, notes, etc. in the AR management system. Maintains compliance with FDCPA, FCRA, HIPAA plus local, state and federal regulations. Demonstrates attention to detail, achieves the determined production and quality expectations and works well under pressure. Responsibilities
Responsible for claims processing and timely insurance follow up. Provide customer service to all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Provide exceptional customer service with all payers. Relay information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to management. Recognize trends in the aging reports and work with payers to decrease response/payment turnaround. Working knowledge of billing claims system. Review, understand, and work unpaid claim denials and rejections, make necessary corrections through worklists and reporting tools. Conduct eligibility and denial reviews. Respond promptly to all correspondence (fax, email, telephone, mail) and ensure timely filing deadlines are met where applicable. Initiate appeal requests per payer guidelines in a timely manner. Verify all demographic and insurance information in patient registration and provide feedback to front office staff to ensure accuracy and timely reimbursement. Ability to research, understand and educate on payer contracts when needed. Monitor various payers bulletins and educational updates to provide information to appropriate team members. All other duties as assigned by department. Qualifications
Education / Training
High School Diploma/Equivalent Experience Requirements
5 to 7 years Insurance Follow-up Denials, Appeals Preferences
Extensive working knowledge of insurance accounts receivable collections and claims follow up. Extensive working knowledge of Florida payer guidelines and insurance carrier payment rules. Ability to appeal claims based on extensive working knowledge of payer/claim issues. Familiarity with claim software and clearinghouse. Familiarity with both government and commercial insurance plans. Experience with denial and appeal process.
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