Insurance Specialist - CPAR Required - 8 AM - 4:30 PM Eastern

Job Category:

Revenue Cycle

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Insurance Specialist serves as a key contact for patient questions related to insurance claims, denials, coding, re-determinations, attorney settlements, and retro authorizations. The Insurance Specialist handles resolving credit balances and pay discrepancies, reviewing prior billing activity and correcting errors. The Insurance Specialist serves as a subject matter expert on payer guidelines, focusing on underpayment recovery, aged denial resolution, and supporting claim adjudication.

Minimum Job Qualifications

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Licensure or other certifications: Certified Patient Account Representative (CPAR) and Certified Professional Biller (CPB) or Certified Professional Coder (CPC). CPB or CPC can be obtained within one year of hire.

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Educational Requirements: High School Diploma or GED.

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Minimum Experience: Minimum 3 years of medical billing and/or medical coding experience.

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​ Other:

Preferred Job Qualifications

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Preferred Licensure or other certifications:

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Preferred Educational Requirements:

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Preferred Experience:

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Other:

Job Specific and Unique Knowledge, Skills and Abilities

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Knowledge of Revenue Cycle functions, including registration, coding/charge posting, payment posting, and financial assistance.

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Thorough knowledge of patient collections, billing regulations (governmental and commercial), denial follow-up procedures, and interpreting EOBs to resolve posting and billing issues.

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Personal computer proficiency to include all programs necessary to perform job duties and ability to toggle between systems efficiently.

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Strong listening, problem-solving, and customer service skills with the ability to remain calm and professional in stressful situations

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Excellent verbal and written communication skills with strong telephone proficiency.

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Ability to work independently within guidelines.

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Thorough knowledge of HIPAA regulations to protect patient health information.

Essential Tasks and Responsibilities

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Verifies and updates patient insurance coverage.Rebills claims as appropriate. Reviews and updates patient accounts and insurance coverage, rebilling claims as appropriate.

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Meets or exceeds required quality, and productivity performance standards as determined by SPRC leadership.

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Follows scripting and departmental guidelines to ensure quality service

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Researches and resolves patient inquires via phone and electronic messages, deescalating complaints to improve the billing experience, and escalating to leadership when appropriate

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Attends all Weekly/Monthly/Quarterly/Annual department and Department Meetings.

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Works with patient/guarantor to find/add insurance, third-party sponsorship, and settlement.

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Maintains an understanding of health insurance and EOB's, collection processes and techniques, and NGHS Financial Assistance Programs.

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Adapts to frequently changing atmosphere including organizational and technological changes.

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Performs other duties as assigned, including but not limited to work queues, itemized statement requests, providing Detail Bills, 1500s and Ubs

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Promotes and contributes positively to the teamwork of the department by assisting coworkers, contributing ideas and problem-solving with co-workers and helps identify trends affecting patient billing and customer satisfaction.

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Liaises with patients and payers to resolve insurance billing issues, obtain required documentation, and review EOBs for payment accuracy.

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Contacts insurance companies via telephone and websites to reprocess aged facility and professional claims.

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Identifies and corrects posting errors and underpayments or denials that are still within the appeal window, resubmitting claims for late charges and other issues.

Physical Demands

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Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

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Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

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Vision: Heavy, Constantly 66-100% of time

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Kneeling/Stooping/Bending: Occasionally 0-30%

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Standing/Walking: Occasionally 0-30%

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Pushing/Pulling: Occasionally 0-30%

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Intensity of Work: Constantly 66-100%

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Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Originally posted on Himalayas