Student Insurance & Coding Specialist - Student Health Services

TITLE

Student Insurance and Coding Specialist

JOB SUMMARY 

This position serves as the primary insurance coding and billing specialist to maintain TWU compliance with U.S. Department of State and Student Health Insurance requirements.  This position is also responsible for the University Student Health Insurance program; billing and insurance processes, including the monitoring of ICD-9, ICD-10 CPT and HCPCS codes for accuracy; and management of the Foreign Student Insurance enrollment and waiver process.  Performs other complex administrative duties and provides support relative to cashiering and payment processing.  A working knowledge of health insurance policies and procedures is required.  Work is performed under the direction of the Assistant Director of Student Health Services as part of the health care team and performance evaluation is based upon completion of assignments and results obtained. The performance evaluation is conducted through the performance evaluation system and in accordance with the University Policies & Procedures.

ORGANIZATIONAL RELATIONSHIPS

Reports to:      Assistant Director, Student Health Services 

Supervises:     May supervise Student Assistants 

ESSENTIAL DUTIES - May include, but not limited to the following:

• Serves as student health insurance specialist with a vast knowledge and application of all aspects of health insurance claims filing for student health services.

• Reviews patient encounters for proper use of procedures codes/modifiers diagnoses codes.

• Utilizes CPT, ICD-9, ICD-10 and HCPCS manuals, and insurance policies to ensure accurate coding has been used to optimize reimbursement.

• Reads and understands payor specific billing requirements as outlined in procedure manuals, payor newsletters and internal communications and incorporates any updates.

• Reviews claim and account data and makes applicable corrections to ensure claims meet all payor specific compliance guidelines and accounts are accurate.

• Posts payments from Explanation of Benefits received and process insurance correspondence.

• Corrects rejected claims and files for reconciliation.

• Performs appeals processing tasks as required from insurance companies in time efficient manner.

• Consults outside physician offices and hospitals for claims and coverage information.

• Reviews proposed fee schedule and recommends necessary adjustments to Assistant Director of Student Health Services.

• Manages the administrative function of the Foreign Student Insurance Program.

• Educates parents, students, graduates and employees, etc. on the student insurance benefits and processes.

• Posts insurance premium charges to individual student accounts each semester for F1/J1 students.

• Evaluates multiple insurance policies to verify comparable coverage to TWU Student Insurance Plan and Department of State minimum requirements.

• Approves and denies waiver request forms and alternative insurance submissions after review for compliance with Federal regulations for all non-immigrant students.

• Processes credits to Student Accounts for insurance premium charges when Waivers are accepted, notifies student when waivers are denied.

• Consults with International students concerning their waiver request eligibility and insurance coverage.

• Addresses questions and concerns for individuals regarding waivers, plans, benefits, enrollment and claims settlement.

• Coordinates with insurance company plan administrators to clarify problematic situations, processing international student enrollment and premium payment.

• Conducts daily audits using Datatel system and Academic HealthPlans website to ensure enrollment and waivers have been processed and completed.

• Negotiates with health care providers and insurance company when errors occur in billing and student coverage.

• Effectively communicates with TWU departments (Bursar, International Office, Schools/Programs) concerning enrollment issues.

• Complies with applicable, laws regulations, policies,