Insurance Coordinator

Location: Carolina Health SpecialistsPosition: Insurance Coordinator
GENERAL SUMMARY OF DUTIES: Responsible for payment of claims using established Central Billing Office policies and procedures. Work unpaid/denied claims by payers. Review and work paid claims for reimbursement accuracy. Interact with office/clinical staff, patients and healthcare plan representatives in regards to these claims.
SUPERVISION RECEIVED: Reports to Business Office Manager.
SUPERVISION EXERCISED: None
TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time and working in office environment. Some bending and stretching required. Working with telephone and computer required. Manual dexterity required for use of calculator, mouse and computer keyboard.
TYPICAL WORKING CONDITIONS: Normal office environment.
Experience: Two years experience in healthcare organization. One year of experience directly involving third payers and insurance companies. Certificate/License: CPC-A or CPC through AAPC preferred but not pre-requisite.
ALTERNATE TO MINIMUM QUALIFICATIONS: Appropriate education may be substituted for two years of insurance experience.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as need evolves.

EXAMPLES OF DUTIES: (This list may not include all of the duties assigned.)

• Researches all outstanding claims through the claims worklist in Athenanet to include but not limited to: ‘Hold’, ‘Manager Hold’ and ‘Fully Worked Receivables’.
• Acts as resource to physicians and office staff on insurance payer payment policies and procedures.
• Ensures timely response from payers of assigned claims.
• Researches correspondence and refund/recoupment requests from insurance carriers in timely manner and makes sure payer contract language is followed by both parties.
• Responds to all claim denials for research and appeal according to CBO policies and procedures through reviewing medical records, reviewing for supporting documentation and following the payers’ appeal process for adjudication adjustment.
• Brings problems to the attention of supervisor.
• Assists with answering patient questions regarding their specific insurance plan.
• Implements special projects with payer representatives as needed for proper processing of claims to target specific problems.
• Participates in educational activities.
• Maintains strictest confidentiality abiding by HIPAA regulations.
• Performs related work as required.

PERFORMANCE STANDARDS:

• Age of outstanding claims should be consistent with MGMA standards as outlined in the monthly posted aged accounts.
• Average of a minimum of 90 claims worked per week which will be measured through claim note productivity.

JOB REQUIREMENTS:

• Knowledge of billing procedures, insurance policy and procedures and outpatient office/clinical operating policies and procedures.
• Skill in using computer and calculator.
• Ability to examine documents for accuracy and completeness.
• Ability to prepare records in accordance with detailed instructions.
• Ability to work effectively with co-workers and patients.
• Ability to communicate clearly.

Please note this position is posted on behalf of our partner practices. This individual will be working at the specific practice that is mentioned in the above details and will not be a direct employee of Aledade, Inc. so will therefore not be eligible for the benefits available to Aledade employees.