Insurance Specialist I

Description

About Our Company

Advanced Diabetes Supply® was founded on the bold principle of creating a knowledgeable, reliable and demonstrably superior diabetes supply company. Our approach, coupled with a commitment to service and innovation, has catapulted Advanced Diabetes Supply® to a national leader in the industry. Creating high-performance, adaptive teams requires a relentless commitment to hiring the best. We strive to maintain a casual, fun environment whenever possible, but we don’t just play around. We work hard every day to provide a positive work culture and respectful atmosphere. The standards we set for ourselves are high, and we love to be challenged! If you enjoy working in a collaborative environment, have a passion for excellence and a bias for action, we may be just what you’ve been looking for.

Interested in learning more about our company and its culture? Visit us at www.northcoastmed.com 

 

Position Summary  

The Insurance Specialist is responsible for interpreting and verifying coverage for our patients; maintaining correct insurance information on patient accounts; as well as re-billing denials. The Insurance Specialist will work within the scope of responsibilities as dictated below with guidance and support from our Insurance & Billing leadership teams.

 Essential Functions  

• Reviews, verifies, and interprets Medicare Eligibility Report to determine best coverage through medical or pharmacy benefit.
• Conducts outbound calls to insurance companies and determines if patient will be serviced thru DME or pharmacy. Contacts patients if additional insurance information is needed.
• Performs test claims to determine copayments and verify preferred products.
• Pursues prior authorizations as determined by health plan or medical group requirements.
• Maintains detailed records in company database; ensures patient primary insurance is accurate and entered in the appropriate system; documents all insurance information into each account, including patient copayments and deductible amounts.
• Verifies insurance.
• Handles all inbound calls from patients and insurance companies regarding any payments made from the insurance company.
• Resolves all denials and processes appeals for all private insurances and some Medicare patients.
• Submits all required documentation to appropriate insurance providers.
• Bills orders corresponding to a denial or change to a patients’ accounts.
• Achieves maximum reimbursement for services provided.
• Rebills claims to insurance companies via paper or electronically.
• Contacts insurance companies to obtain claim status.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback as to improve processes and policies.
• Attends all department, team, and company meetings as required.
• Embraces and exemplifies ADS core values:

          We put our people first.               

          We serve our members with passion.              

          We take ownership.              

          We pursue excellence.               

          We never stop growing.

• May perform any additional responsibilities or special projects as required. 
• Duties and responsibilities may be subject to change based upon the needs of the department.

Requirements

• High School diploma or equivalent
• Knowledge of insurance verification and/or authorization, billing and processing claims
• Basic knowledge of billing guidelines and resources for Medicare and Private insurances
• Basic knowledge of insurance portals; familiarity with a variety of medical and/or insurance terms or practices
• Proficiency in basic math and business calculations
• Working knowledge of computer/data entry with the ability to learn new systems
• Basic level of MS Office proficiency

 Expected Competencies  

• Friendly, professional and effective communications skills; able to calmly present solutions in challenging situations
• Effective interpersonal skills
• Clear diction and knowledge of the English language, both written and verbal
• Service-orientation and aptitude to resolve insurance and/or patient matters
• Self-directed accountability and reliability
• Cultural competence

Physical Demands 

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable acc