Insurance Billing Specialist Job Description
Insurance billing specialist
provides timely and accurate collection of payment from insurance carriers, patients, agencies, and others for equipment, medication, and services.
Insurance Billing Specialist Duties & Responsibilities
To write an effective insurance billing specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included insurance billing specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Processes pass through room & board claims for Hospice Medicaid and works cooperatively with nursing home facilities to insure accurate and timely processing of payments, coordination within finance to insure accurate monthly matching of this revenue to corresponding expense on the financials
Insurance eligibility and verification
Posting daily charges
Submitting claims and appeals
Maintain correspondence with carriers
Processing remittances
Insurance Aging reports
Posting Insurance payments
Patient interaction regarding balances and insurance questions
Review and resolve billing edits in EPIC and in claims scrubber system
Insurance Billing Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Insurance Billing Specialist
Typically a job would require a certain level of education.
Employers hiring for the insurance billing specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Associates, Education, General Education, Finance, Medical, Accounting, Business, Business/Management, Pharmacy, Health Care Administration
Skills for Insurance Billing Specialist
Desired skills for insurance billing specialist include:
Email
Internet navigation and research
Medicaid
Complete mortgage servicing process from origination to payoff
Copy equipment are essential
Drug and payor criteria
Fax transmission
High touch specialty medication
Order to review and approve insurance-related disbursements and payments
Accounting principles
Desired experience for insurance billing specialist includes:
Travel to various office locations may be required
Must have at least 3 years of operational billing/collecting experience in a medical setting
Must know ICD10, CPT and modifiers
Skilled in pin-pointing problem accounts and determining a plan of action
Ability to coordinate with the billing supervisor to assess and consolidate all problems
Possess strong skills in organization
Insurance Billing Specialist Examples
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Insurance Billing Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for an insurance billing specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance billing specialist
- Reconcile claim runs, create electronic claim files, and resolve errors
- Resolve claims editing issues and interact with third party clearinghouse or the claims scrubber vendor to produce clean claims
- Identify recurring billing errors and trends and report them to supervisor when necessary
- Conduct research / analyze coding errors, document billing issues / trends, and assist with problem solving and solutions
- Process credit balances due to regulatory payers
- Proactively collect active outstanding A/R from regulatory payers
- Contact insurance payers by either phone or online inquiry regarding unpaid hospital claims
- Review remaining balances on accounts after insurances have paid to determine appropriate next action
- Review denials by regulatory payers for entire claims or line items to determine if additional follow up is needed or assistance from other internal departments and forward to them as needed
- Ensures efficient processing of denials and appeals
Qualifications for insurance billing specialist
- Must be punctual with follow-ups
- Experience with medical claims submission
- Working knowledge of OS Office, Excel and Outlook
- Must be able to work 1st or 2nd shift M-F
- Must have experience working in a scripted phone environment
- Must have 1-2 years of recent Customer Service experience in a call center environment
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Insurance Billing Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for an insurance billing specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance billing specialist
- Serves as a communication link to various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization
- Communicates team barriers, process flow or productivity issues to the supervisor
- Monitors the status of denials, appeals, and claim errors by using work queues and conducting routine, periodic follow up on previously researched claims items
- You will be reconciling payments and invoices from groups and carriers reconciling lock-box payments
- Printing and working with printed invoices
- All staff is required to answer phones, so you will be expected to have basic customer service skills and will be responsible for handling accounts payable/receivable issues over the phone
- Processes incoming payments both through ERA and manually
- Posts claim rejections both manually and ERA accurately in patient’s accounts with payor rejection returns as priority
- Processes claim remittance, reconciles and accepts claims
- Reconciles and logs payment batches daily on the Finance Deposit Spreadsheet
Qualifications for insurance billing specialist
- Previous billing, QA or experience working in an outpatient clinic is highly preferred
- Research and respond to customer inquiries in a high volume call center for a Fortune 100 insurance company
- Candidates must be experienced in providing world class customer service
- Responsibilities include but are not limited to taking inbound calls from customers to process payments, offer billing solutions, and send requested documents for homeowner and auto insurance policies
- In addition, there may be some interaction with third party vendors with requests to modify lender information and/or verify policy coverage
- This is an excellent opportunity which is ideally utilized to prepare contracted representatives for a permanent career at with the Insurance Client
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Insurance Billing Specialist Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of insurance billing specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for insurance billing specialist
- Ensure that Health Services Asset Management is in compliance with all state regulations relating to insurance, bankruptcy, probate and liens
- Treat payors and patients with respect protecting their privacy
- Take initiative to secure payment or resolve account balances
- Resolve exceptions to ensure the proper flow of accounts through the collections process
- Potentially processing commission payments as well
- Act as a representative of PBD and proactively contact insurance carriers regarding reduced or denied reimbursement and ensure patient insurance information is accurate
- Retrieve various types of medical documentation and develop, submit and track appeals to carriers, per department procedure
- Review and analyze all incoming explanation of benefits and adjust patient’ accounts to reflect the carrier decisions on the patient’s statement
- Make work assignments to team members and track completion of tasks
- Processes accounts daily in all assigned work queues in EPIC and ensures information is entered accurately in order to obtain claims for the appropriate payers
Qualifications for insurance billing specialist
- Depending on performance this position could lead to conversion into a permanent position within as a licensed insurance professional after 90 days
- Basic computer skills (MS Word and Excel), database, data entry and website navigation experience
- Comfortable working with numbers and spreadsheets
- Attention to detail and multitasking skills are a must!
- The member base is mainly retirees which requires patience and a positive attitude
- Knowledge of physician’s billing and collection procedures, ICD10-CM and CPT codes and knowledge of Excel and Word
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Insurance Billing Specialist Job Description
Job Description Example
Our growing company is looking for an insurance billing specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance billing specialist
- Reviews returned claims and verifies correct data elements that will facilitate processing of the claim
- Work accounts in a thorough and accurate manner
- Appropriate action shall be taken on accounts worked
- Reviews correspondence and takes action as appropriate to update the patient account record, both current and historical, and insure the accurate production of claims
- Review and follow up on insurance accounts with outstanding balances
- Responsible to assess and process all correspondence to include EOB’s for provided accounts claim research on insurance online portals as needed
- Capable to work denials from the billing clearinghouses such as Zirmed, Availity, and Exchange Healthcare
- Initiate and follow up on claim appeals after all other efforts for payment have been exhausted as merited by insurance company
- Identify and correct billing errors and convey these issues with the billing team complete cash application forms for the posting team in the event there are dates of services with incorrect posting information
- Review and prepare resubmission of claims for manual and/or electronic billing print and mail claim forms as necessary for account resolution
Qualifications for insurance billing specialist
- Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation
- Ability to handle patient and organizational information in a confidential manner
- Ability to exercise independent judgment within scope of knowledge and responsibility
- Must possess a minimum of one (1) year of third party billing experience in a healthcare setting, preferably for Skilled Nursing Facility billing criteria
- Must possess the ability to prioritize duties and responsibilities
- Experience working with Direct Data Entry (DDE)
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Insurance Billing Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for an insurance billing specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance billing specialist
- Communicate immediately with supervisors on any insurance issues, trends or reimbursement setbacks that may affect cash flow by monitoring insurance accounts
- Promptly answer phones in a courteous and friendly manner following call quality program standards
- Promptly return all patient voice mail following call quality program standards
- Document discussions with and/or promises from all patient phone calls
- Process correspondence from patient statements
- Complete rush refund requests
- Accurately processes patient payments
- Communicates payment guidelines, sets up recurring patient payments
- Contact insurance companies and lab companies by phone, fax, and written correspondence to resolve issues preventing claims from being processed correctly
- Communicate with coding staff to verify claims have been coded correctly, assign claims to Insurance AR for completion of appeal
Qualifications for insurance billing specialist
- Very comfortable learning new systems and working with very manual processes
- Minimum two years health care account management experience
- Prefer a four year college degree in business or health care business
- Prior ecxperience in a hospital setting, health insurance claims processing or medical office
- Minimum two (2) years experience in patient account billing and collections
- General knowledge of medical terminology and ICD10 coding