PURPOSE OF THIS POSITION
The purpose of the Insurance Specialist is to direct and coordinate the overall functions of medical billing for procedures performed in the surgery center to ensure accurate billing and payment while improving patient, physician, and other customer relations. This position acts as a liaison between the facility and payment parties. Maintains a good working knowledge of all managed care contracting. Maintains a current payer matrix. Assists with surgery authorization as needed. Discusses patient bills/questions and insurance negotiations.
JOB DUTIES/RESPONSIBILITIES
Duty 1: Bills insurance for medical services
Duty 2: Coordinates reimbursement activities with payers.
Duty 3: Resolves financial conflicts appropriately and professionally.
Duty 4: Receives patient treatment codes to use in assembling reimbursement claims.
Duty 5: Creates reimbursement claims and transfers to third-party payers.
Duty 6: Assists with the transcription, coding and billing.
Duty 7: Discusses all insurance and billing questions with the patient.
Duty 8: Investigates all claim denials by third-party payer.
Duty 9: Maintains insurance matrix.
Duty 10: Accepts full responsibility for his/her actions.
REQUIRED QUALIFICATIONS
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