FLSA : Non-Exempt
Reports To : Silvia McDaniel
Main Function :
As a member of the care team, the Certified Coder is responsible for working collaboratively with other team members to assure the safe, timely and accurate delivery of patient care. The Insurance Specialist is responsible for the filing of insurance claims, including review of aged accounts receivable and outstanding claims reports utilizing appropriate CPT procedure and ICD-10 diagnosis codes.
Customer Service
- Operates within the concept of patient focused care
- Anticipates patient needs
- Delivers caring, timely service with positive body language
- Presents good telephone skills
- Greets patients at every stage of the visit
- Responds promptly to patient needs requests
- Responds promptly to Physician and team member requests and inquiries
- Participates as an active, positive member of the TOI team
Insurance Specialist Duties
Processes all insurance claims for assigned areaAnalyzes and resolves physician claim rejects and denials.Identifies trends / problems in billing process and presents viable solutions.Processes mail receipts for their respective patient types by posting payment to appropriate account, and review EOB for correct adjustment.Submits adjustment and refund requests with appropriate documentation.Reviews aged accounts receivable and outstanding reports for appropriate trackingCompiles monthly reports as requestedAssists with physician billing and document trainingPerforms related work, as requiredQualifications
High school diploma or equivalentThree to Five years of experience in medical billing environmentOne year of work experience in a medical settingKnowledge of medical terminologyWord processing and computer experienceMust have experience creating spreadsheets, reports, and trends dataMental / Physical Requirements
Ability to work well under pressure with diverse groups of professionals and physiciansAbility to communicate written and oral ideas and plan effectivelyRequires good communication and organizational skillsRequires reasoning ability and good independent judgmentMust be sensitive to cultural and bilingual issuesRequires working under stressful conditions and irregular hours
Requires working with frequent interruptionsRequires tolerance of standing or sitting posture up to (4 hours) continuously, for a total of up to (10 hours) per (12 hours)Required to operate computer keyboard, mouse, and monitor for a total of up to (8 hours) per (12 hours)Working Conditions (environmental)
Risk of occupational exposure to blood and other potentially infectious materials (OPIM)Possible risk of physical injury due to moving machinery and supplies