Tanner Health System
Insurance Specialist - Patient Financials (Days)
Tanner Health System, Carrollton, Georgia, us, 30112
The Insurance Specialist is responsible for the follow up of all accounts within the commercial accounts receivable, which includes all contracted and non-contracted commercial, VA, TriCare and specialty insurance plans. This position requires thorough knowledge and understanding of most commercial billing requirements. Experience using Availity, United Healthcare, Cigna and other payer portals, along with Epic experience is a plus. This position also requires excellent customer service skills and attention to detail. 2 years hospital Patient Accounts experience desired.
Required Knowledge & Skills
Education: High School Diploma or GED
Experience: Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.
Licenses and Certifications
NONE REQUIRED
Supervision
No supervisory responsibilities
Qualifications
Two years experience in insurance billing or insurance collections, and patient contact in a hospital, clinic, or physician office. May substitute customer service, teaching, sales, collection, or other occupations, which require control of conversation, heavy detail, and ability to negotiate and compromise when necessary
Ability to work closely with others, and function as a team member
Ability to analyze and prioritize workloads
Proficiency in spelling, business letter writing, and medical terminology
Knowledge and experience with Internet, Word, and Excel
Ability to be assertive without being abrasive
Good verbal communication skills
The ability to understand and work within multiple applications and systems. Both internally and externally.
Statement Of Employment Philosophy
Being a part of Tanner Health System is more than a job, it is a promise we make to treat every patient with exceptional service every time they walk through our doors. Service excellence is the foundation of our organizational culture and the expectations we all set for each other, our patients, physicians and our community. All employees agree to abide by a set of service standards. These standards are the promise we make to provide the best care possible, and represent our beliefs, values and who we strive to become. We each commit to making Tanner Health System a great place for our employees to work, for patients to receive care and for physicians to practice medicine.
Functions
Area of Responsibilities
Provides comprehensive customer service functions, including responding to patient inquiries and complaints from all sources in a timely and thorough manner. This function requires interaction with internal departments and physician's offices.
Daily review of all unprocessed billing errors and edits to ensure compliant and timely claims submission. Review and resolution of all claim rejections that are returned from the clearinghouse. Interacts with Team Lead, PFS Director and various internal departments to resolve billing edits. The Insurance Specialist is responsible for the billing of all Blue Cross, commercial managed care, Tricare, ChampVA, Veterans Administration, and other non governmental payers within expected payer timely guidelines.
Conducts daily follow up based on an alpha split within the assigned individual and team work queues. This includes calls to the payer to research and discuss unprocessed accounts. These inquiries require diligence and patience to obtain the details of unresolved accounts receivable. Follow up activities also include researching authorizations, appeals, and denials on various payer websites.
Reviews and researches all denials posted from remittance advices. Sends coding denials to the HIM Team for review and resolution. Sends charge and billing denials to the Revenue Integrity Team for review and resolution. Technical denials will be thoroughly researched and resolved as soon as the denial is discovered to ensure timely appeal or corrected billing. Reports denial trends to Team Lead or PFS Director to be shared with Payer Provider Representatives and internal committees.
Requires thorough knowledge of commercial payer rules, regulations, policies and procedures related to billing, appeals and follow up of the Commercial accounts receivables.
Reviews, processes and scans commercial payer correspondence received. May reassign correspondence to other areas as it pertains to coding, charge or appeal issues.
Reviews, researches and processes refund correspondence and requests from insurance carriers. If an appeal is required, will forward to the appropriate team for review. If refund request is approved, will forward to appropriate team for refund.
Works with the other departments in each facility such as Registration, Physicians offices, Medical Records and Coding/Abstracting in making necessary corrections to charges. Recommends process changes which may reduce the frequently of late or lost charges, or eliminates them reduce the frequency of late or lost charges, or eliminates them altogether. Ensures timely filing and acceptance of claims for prompt payment. This significantly impacts cash flow and AR days.
Maintains good relationships with doctor's offices for the purpose of exchange of mutually necessary information. Contacts doctor's office when outpatient facility claims are denied due to lack of authorization or question of medical necessity. Attempts to obtain clinical information and or letter of medical necessity for appeal of denied charges. Maintains follow-up with insurance company for resolution by payment or adjustment. Success in this area will increase overturn of denials, lower AR days and improved cash flow.
Maintains good working relationships with other teams which includes transferring responsibility for accounts only when such transfers are justified. Reviews accounts to assure primary insurance claims are processed and resolved and appropriate documentation is received from the primary insurance in order to file to the next payer.
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.
Required Knowledge & Skills
Education: High School Diploma or GED
Experience: Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.
Licenses and Certifications
NONE REQUIRED
Supervision
No supervisory responsibilities
Qualifications
Two years experience in insurance billing or insurance collections, and patient contact in a hospital, clinic, or physician office. May substitute customer service, teaching, sales, collection, or other occupations, which require control of conversation, heavy detail, and ability to negotiate and compromise when necessary
Ability to work closely with others, and function as a team member
Ability to analyze and prioritize workloads
Proficiency in spelling, business letter writing, and medical terminology
Knowledge and experience with Internet, Word, and Excel
Ability to be assertive without being abrasive
Good verbal communication skills
The ability to understand and work within multiple applications and systems. Both internally and externally
Definitions
The Insurance Specialist is responsible for the follow up of all accounts within the commercial accounts receivable, which includes all contracted and non-contracted commercial, VA, TriCare and specialty insurance plans. This position requires thorough knowledge and understanding of most commercial billing requirements. Experience using Availity, United Healthcare, Cigna and other payer portals, along with Epic experience is a plus. This position also requires excellent customer service skills and attention to detail. 2 years hospital Patient Accounts experience desired.
Position Responsibilities
Contact with Others: Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.
Effect of Error: Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient's welfare or the organization's interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization's position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.
People Management Responsibilities
Supervisory Responsibility: Exercises no supervision, work direction, or instruction of other employees or students
Work Environment/Physical Effort
Mental Demands: Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.
Working Conditions: Generally pleasant working conditions/normal office environment.
Working Conditions Aspects for Immunizations
Performs tasks involving contact with blood, blood-contaminated body fluids, other body fluids, or sharps (needles): No
Directly works with Patients less than 12 months of age: No
Physical Effort: Moderate physical effort - Lifts, carries, or handles lightweight (1 to 25 lbs.) materials or equipment for about half of the day. Very occasional physical effort with medium weight objects (25- 60 lbs.). Office or laboratory work requires close visual effort and concentration more than half of day. Works in reaching or strained positions for less than half of day.
Physical Aspects
Bending: Not required
Typing: Constant = 67% - 100% of the time.
Hearing: Constant = 67% - 100% of the time.
Visual: Constant = 67% - 100% of the time.
Speaking: Constant = 67% - 100% of the time.
Standing: Occasional = 1% - 33% of the time
Walking: Occasional = 1% - 33% of the time
Lifting up to 25 lbs.: Occasional = 1% - 33% of the time
Lifting 25 to 60 lbs.: Not required
Lifting over 60 lbs.: Not required
Carrying: Occasional = 1% - 33% of the time
Climbing: Not required
Kneeling: Not required
Tasting: Not required
Smelling: Not required
Manual Dexterity -- picking, pinching with fingers etc.: Frequent = 34% - 66% of the time
Feeling (Touch) -- determining temperature, texture, by touching: Not required
Reaching -- above shoulder: Not required
Reaching -- below shoulder: Occasional = 1% - 33% of the time
Color Vision: Occasional = 1% - 33% of the time
Balancing: Occasional = 1% - 33% of the time
Crawling: Not required
Running - in response to an emergency: Not required
Handling -- seizing, holding, grasping: Occasional = 1% - 33% of the time
Squatting: Not required
Driving -- Utility vehicles such as golf carts, Gators, ATV, riding lawnmowers, skid steer, aerial lift: Not required
Driving -- Class C vehicles: Not required
Driving -- CDL class vehicles: Not required
N95 Respirator usage (PPE): Not required
Hazmat suit usage (PPE): Not required
Pushing/Pulling -- up to 25 lbs.: Not required
Pushing/Pulling -- 25 to 60 lbs.: Not required
Pushing/Pulling -- over 60 lbs. : Not required
Required Knowledge & Skills
Education: High School Diploma or GED
Experience: Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.
Licenses and Certifications
NONE REQUIRED
Supervision
No supervisory responsibilities
Qualifications
Two years experience in insurance billing or insurance collections, and patient contact in a hospital, clinic, or physician office. May substitute customer service, teaching, sales, collection, or other occupations, which require control of conversation, heavy detail, and ability to negotiate and compromise when necessary
Ability to work closely with others, and function as a team member
Ability to analyze and prioritize workloads
Proficiency in spelling, business letter writing, and medical terminology
Knowledge and experience with Internet, Word, and Excel
Ability to be assertive without being abrasive
Good verbal communication skills
The ability to understand and work within multiple applications and systems. Both internally and externally.
Statement Of Employment Philosophy
Being a part of Tanner Health System is more than a job, it is a promise we make to treat every patient with exceptional service every time they walk through our doors. Service excellence is the foundation of our organizational culture and the expectations we all set for each other, our patients, physicians and our community. All employees agree to abide by a set of service standards. These standards are the promise we make to provide the best care possible, and represent our beliefs, values and who we strive to become. We each commit to making Tanner Health System a great place for our employees to work, for patients to receive care and for physicians to practice medicine.
Functions
Area of Responsibilities
Provides comprehensive customer service functions, including responding to patient inquiries and complaints from all sources in a timely and thorough manner. This function requires interaction with internal departments and physician's offices.
Daily review of all unprocessed billing errors and edits to ensure compliant and timely claims submission. Review and resolution of all claim rejections that are returned from the clearinghouse. Interacts with Team Lead, PFS Director and various internal departments to resolve billing edits. The Insurance Specialist is responsible for the billing of all Blue Cross, commercial managed care, Tricare, ChampVA, Veterans Administration, and other non governmental payers within expected payer timely guidelines.
Conducts daily follow up based on an alpha split within the assigned individual and team work queues. This includes calls to the payer to research and discuss unprocessed accounts. These inquiries require diligence and patience to obtain the details of unresolved accounts receivable. Follow up activities also include researching authorizations, appeals, and denials on various payer websites.
Reviews and researches all denials posted from remittance advices. Sends coding denials to the HIM Team for review and resolution. Sends charge and billing denials to the Revenue Integrity Team for review and resolution. Technical denials will be thoroughly researched and resolved as soon as the denial is discovered to ensure timely appeal or corrected billing. Reports denial trends to Team Lead or PFS Director to be shared with Payer Provider Representatives and internal committees.
Requires thorough knowledge of commercial payer rules, regulations, policies and procedures related to billing, appeals and follow up of the Commercial accounts receivables.
Reviews, processes and scans commercial payer correspondence received. May reassign correspondence to other areas as it pertains to coding, charge or appeal issues.
Reviews, researches and processes refund correspondence and requests from insurance carriers. If an appeal is required, will forward to the appropriate team for review. If refund request is approved, will forward to appropriate team for refund.
Works with the other departments in each facility such as Registration, Physicians offices, Medical Records and Coding/Abstracting in making necessary corrections to charges. Recommends process changes which may reduce the frequently of late or lost charges, or eliminates them reduce the frequency of late or lost charges, or eliminates them altogether. Ensures timely filing and acceptance of claims for prompt payment. This significantly impacts cash flow and AR days.
Maintains good relationships with doctor's offices for the purpose of exchange of mutually necessary information. Contacts doctor's office when outpatient facility claims are denied due to lack of authorization or question of medical necessity. Attempts to obtain clinical information and or letter of medical necessity for appeal of denied charges. Maintains follow-up with insurance company for resolution by payment or adjustment. Success in this area will increase overturn of denials, lower AR days and improved cash flow.
Maintains good working relationships with other teams which includes transferring responsibility for accounts only when such transfers are justified. Reviews accounts to assure primary insurance claims are processed and resolved and appropriate documentation is received from the primary insurance in order to file to the next payer.
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.
Required Knowledge & Skills
Education: High School Diploma or GED
Experience: Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.
Licenses and Certifications
NONE REQUIRED
Supervision
No supervisory responsibilities
Qualifications
Two years experience in insurance billing or insurance collections, and patient contact in a hospital, clinic, or physician office. May substitute customer service, teaching, sales, collection, or other occupations, which require control of conversation, heavy detail, and ability to negotiate and compromise when necessary
Ability to work closely with others, and function as a team member
Ability to analyze and prioritize workloads
Proficiency in spelling, business letter writing, and medical terminology
Knowledge and experience with Internet, Word, and Excel
Ability to be assertive without being abrasive
Good verbal communication skills
The ability to understand and work within multiple applications and systems. Both internally and externally
Definitions
The Insurance Specialist is responsible for the follow up of all accounts within the commercial accounts receivable, which includes all contracted and non-contracted commercial, VA, TriCare and specialty insurance plans. This position requires thorough knowledge and understanding of most commercial billing requirements. Experience using Availity, United Healthcare, Cigna and other payer portals, along with Epic experience is a plus. This position also requires excellent customer service skills and attention to detail. 2 years hospital Patient Accounts experience desired.
Position Responsibilities
Contact with Others: Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.
Effect of Error: Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient's welfare or the organization's interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization's position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.
People Management Responsibilities
Supervisory Responsibility: Exercises no supervision, work direction, or instruction of other employees or students
Work Environment/Physical Effort
Mental Demands: Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.
Working Conditions: Generally pleasant working conditions/normal office environment.
Working Conditions Aspects for Immunizations
Performs tasks involving contact with blood, blood-contaminated body fluids, other body fluids, or sharps (needles): No
Directly works with Patients less than 12 months of age: No
Physical Effort: Moderate physical effort - Lifts, carries, or handles lightweight (1 to 25 lbs.) materials or equipment for about half of the day. Very occasional physical effort with medium weight objects (25- 60 lbs.). Office or laboratory work requires close visual effort and concentration more than half of day. Works in reaching or strained positions for less than half of day.
Physical Aspects
Bending: Not required
Typing: Constant = 67% - 100% of the time.
Hearing: Constant = 67% - 100% of the time.
Visual: Constant = 67% - 100% of the time.
Speaking: Constant = 67% - 100% of the time.
Standing: Occasional = 1% - 33% of the time
Walking: Occasional = 1% - 33% of the time
Lifting up to 25 lbs.: Occasional = 1% - 33% of the time
Lifting 25 to 60 lbs.: Not required
Lifting over 60 lbs.: Not required
Carrying: Occasional = 1% - 33% of the time
Climbing: Not required
Kneeling: Not required
Tasting: Not required
Smelling: Not required
Manual Dexterity -- picking, pinching with fingers etc.: Frequent = 34% - 66% of the time
Feeling (Touch) -- determining temperature, texture, by touching: Not required
Reaching -- above shoulder: Not required
Reaching -- below shoulder: Occasional = 1% - 33% of the time
Color Vision: Occasional = 1% - 33% of the time
Balancing: Occasional = 1% - 33% of the time
Crawling: Not required
Running - in response to an emergency: Not required
Handling -- seizing, holding, grasping: Occasional = 1% - 33% of the time
Squatting: Not required
Driving -- Utility vehicles such as golf carts, Gators, ATV, riding lawnmowers, skid steer, aerial lift: Not required
Driving -- Class C vehicles: Not required
Driving -- CDL class vehicles: Not required
N95 Respirator usage (PPE): Not required
Hazmat suit usage (PPE): Not required
Pushing/Pulling -- up to 25 lbs.: Not required
Pushing/Pulling -- 25 to 60 lbs.: Not required
Pushing/Pulling -- over 60 lbs. : Not required