Associated Urological Specialists LLC
Insurance Specialist
Associated Urological Specialists LLC, Orland Park, Illinois, United States, 60467
OVERVIEW:
The
Insurance Specialist position requires fundamental knowledge of filing insurance claims, howinsurance companies pay accordingly to contracts established within AUS oraffiliated hospitals, how to read and interpret an insurance explanation ofbenefits (EOB), and do precise follow-up with the insurance company via phone,email, fax, insurance websites, etc. at an acceptable volume per day.
The Insurance Specialist willbe the embodiment of AUS' mission, vision and values. The Insurance Specialistwill greet patients or family members upon arrival within our AUS offices andassist them in answering any concerns they may have regarding billing issuesand direct them to the appropriate individual/team for resolution. TheInsurance Specialist will have knowledge of all aspects of the departmentprocess from patient registration to billing.
REPORTING STRUCTURE
:
TheInsurance Specialist works under the direct supervision of the Office Managerbut will be working in conjunction with the Senior Controller under thedepartment of Accounting and Control.
ACCOUNTABILITIES/NATURE ANDSCOPE:
The Insurance Specialist/APCC willhave the following accountabilities (but are not limited to):
1. Main point ofcontact between the urological office and the billing department for claimssubmitted when necessary
2. Initiate anyerrors for claim resolution
3. Review dailyaccounts that are ready to be billed
4. Initiatecorrection on all claims with errors by the designated time
5. Follow-up on anycorrespondence that may have been received on that day or the previous day
6. Cross train onbilling all lines of business to different payors
7. Maintain a log ofall Medicare/Medicaid IP accounts that Medicaid pays only a portion of thepatient's responsibility
8. Work all accountsthat have a credit balance
9. Assist in registeringpatients efficiently and accurately, obtaining appropriate signatures,completing all required forms and providing patient information as required bystate and federal regulations and departmental guidelines
10. Assure that allrequired documentation is scanned in appropriately in iSalus for eachregistration to include the following: Driver's license, insurance cards,orders.
11. Successfullycompletes pre-authorizations/pre-certifications/pre-determinations and orverification of benefits for medications, in office procedures, outpatientprocedures, surgeries, and diagnostic testing as directed including injectableor intravenous medications administered in the office setting.
12. Specialist willalso secure demographic and financial information prior to patient arrival.
13. Specialists willinform patients of financial responsibility prior to office visit/procedure
14. Specialist willeffectively communicate with physician's staff and insurance companies toensure the authorization and benefits are obtained prior to services beingrendered.
15. Inform patientsprior to services being rendered if authorization was unable to be obtained, toavoid a denied service claim. Ensures all insurance information is accurate.
16. Documentsauthorization information and uploads information into EMR system, iSalus.
17. Verification ofinsurance eligibility for all clinic services and outpatient procedures.
18. Securepre-certification authorizations for outpatient procedures online or over thephone.
19. Data entry,appointment scheduling, electronic records scanning, and any other dutiesnecessary to provide efficient, timely services to patients.
20. Assisting frontdesk staff on an as needed basis.
21. Validatepatient's information as necessary; enters relevant information into iSalus.
22. Set-up paymentarrangements with self-pay patients
23. Ensure thecollection of deposits and co-pays when applicable
24. Assists patientswith questions regarding their insurance coverage
25. Assists othermembers of the department as needed
26. Protects patientconfidentiality, making sure protected health information (PHI) is secured bynot leaving PHI in plain sight and logging off the computer before leaving itunattended.
27. Ensures properhand off of responsibilities once their task is completed
28. Meets establishedattendance criteria and starts work promptly. Punctual and dependent forassigned/confirmed shifts
29. Respects andacknowledges the organizations commitment to cultural diversity, which isexpressed through behavior, language and actions.
30. Consistentlydemonstrates good use of time and resources.
31. Adherence to HR & Corporate policies and procedures.
32. Ensuring that allmedical records are accurate and complete within the SBU for all patients.
33. Ensuringcompliance of healthcare regulations, medical laws and high ethical standards.
34. Regularly adheresand supports compliance and accreditation efforts as assigned including, butnot limited to OSHA, HIPAA & CMS guidelines for Parts C & D on GeneralCompliance and Fraud, Waste & Abuse.35. Performs other position related duties asassigned
Insurance specialist job description
OTHER DUTIES &RESPONSIBILITIES :
1. Must be able torecognize and respond appropriately to urgent/emergent situations per protocol
2. Completecontinued education/training requirements
3. Perform basictriage per specific office and clinical protocol procedures
4. Respects culturaland religious practices of patients
5. Maintainprofessional appearance at all times
6. Establish andmaintain effective working relationships with physicians, staff and management
7. Effectively copewith typical job stress
8. Participate inperformance improvement and continuous quality improvement activities
9. Document workprocess as required
10. Punctual anddependent for assigned/confirmed shiftsPerform other duties assigned
EDUCATION &CERTIFICATION:
A minimum of High SchoolDiploma or General Education (GED). Graduate from a vocational or collegepreferred. Knowledge in Medical Terminology a plus. Proficiency must beattained via on-the-job training and orientation.
QUALIFICATIONS, SKILLS ANDABILITIES:
The Insurance Specialist
must have a minimum of 1-3 years' experience inhealthcare scheduling, billing and collections, financial counseling in aphysician office setting preferably within the urology specialty. Customerservice skills experience is a must. Excellent oral and written communicationskills. Proficient interpersonal relations skills. Must have strong computerskills to handle clerical tasks, including working with office and EMR systems.Basic Knowledge of health insurance products (HMO, PPO, HSA, Commercial,Medicare etc.). Basic knowledge and understanding of CPT procedure coding andICD-10 diagnostic coding a plus. Physician or Hospital registration or admittingexperience is desirable.
COMPUTER SKILLS:
To perform this job successfully, an individual should havethe knowledge of: Internet Software; Word Processing Software (Microsoft Word);Electronic Mail Software (Microsoft Outlook); Electronic Health Records (EMRSoftware); Practice Management Software (iSalus)
The
Insurance Specialist position requires fundamental knowledge of filing insurance claims, howinsurance companies pay accordingly to contracts established within AUS oraffiliated hospitals, how to read and interpret an insurance explanation ofbenefits (EOB), and do precise follow-up with the insurance company via phone,email, fax, insurance websites, etc. at an acceptable volume per day.
The Insurance Specialist willbe the embodiment of AUS' mission, vision and values. The Insurance Specialistwill greet patients or family members upon arrival within our AUS offices andassist them in answering any concerns they may have regarding billing issuesand direct them to the appropriate individual/team for resolution. TheInsurance Specialist will have knowledge of all aspects of the departmentprocess from patient registration to billing.
REPORTING STRUCTURE
:
TheInsurance Specialist works under the direct supervision of the Office Managerbut will be working in conjunction with the Senior Controller under thedepartment of Accounting and Control.
ACCOUNTABILITIES/NATURE ANDSCOPE:
The Insurance Specialist/APCC willhave the following accountabilities (but are not limited to):
1. Main point ofcontact between the urological office and the billing department for claimssubmitted when necessary
2. Initiate anyerrors for claim resolution
3. Review dailyaccounts that are ready to be billed
4. Initiatecorrection on all claims with errors by the designated time
5. Follow-up on anycorrespondence that may have been received on that day or the previous day
6. Cross train onbilling all lines of business to different payors
7. Maintain a log ofall Medicare/Medicaid IP accounts that Medicaid pays only a portion of thepatient's responsibility
8. Work all accountsthat have a credit balance
9. Assist in registeringpatients efficiently and accurately, obtaining appropriate signatures,completing all required forms and providing patient information as required bystate and federal regulations and departmental guidelines
10. Assure that allrequired documentation is scanned in appropriately in iSalus for eachregistration to include the following: Driver's license, insurance cards,orders.
11. Successfullycompletes pre-authorizations/pre-certifications/pre-determinations and orverification of benefits for medications, in office procedures, outpatientprocedures, surgeries, and diagnostic testing as directed including injectableor intravenous medications administered in the office setting.
12. Specialist willalso secure demographic and financial information prior to patient arrival.
13. Specialists willinform patients of financial responsibility prior to office visit/procedure
14. Specialist willeffectively communicate with physician's staff and insurance companies toensure the authorization and benefits are obtained prior to services beingrendered.
15. Inform patientsprior to services being rendered if authorization was unable to be obtained, toavoid a denied service claim. Ensures all insurance information is accurate.
16. Documentsauthorization information and uploads information into EMR system, iSalus.
17. Verification ofinsurance eligibility for all clinic services and outpatient procedures.
18. Securepre-certification authorizations for outpatient procedures online or over thephone.
19. Data entry,appointment scheduling, electronic records scanning, and any other dutiesnecessary to provide efficient, timely services to patients.
20. Assisting frontdesk staff on an as needed basis.
21. Validatepatient's information as necessary; enters relevant information into iSalus.
22. Set-up paymentarrangements with self-pay patients
23. Ensure thecollection of deposits and co-pays when applicable
24. Assists patientswith questions regarding their insurance coverage
25. Assists othermembers of the department as needed
26. Protects patientconfidentiality, making sure protected health information (PHI) is secured bynot leaving PHI in plain sight and logging off the computer before leaving itunattended.
27. Ensures properhand off of responsibilities once their task is completed
28. Meets establishedattendance criteria and starts work promptly. Punctual and dependent forassigned/confirmed shifts
29. Respects andacknowledges the organizations commitment to cultural diversity, which isexpressed through behavior, language and actions.
30. Consistentlydemonstrates good use of time and resources.
31. Adherence to HR & Corporate policies and procedures.
32. Ensuring that allmedical records are accurate and complete within the SBU for all patients.
33. Ensuringcompliance of healthcare regulations, medical laws and high ethical standards.
34. Regularly adheresand supports compliance and accreditation efforts as assigned including, butnot limited to OSHA, HIPAA & CMS guidelines for Parts C & D on GeneralCompliance and Fraud, Waste & Abuse.35. Performs other position related duties asassigned
Insurance specialist job description
OTHER DUTIES &RESPONSIBILITIES :
1. Must be able torecognize and respond appropriately to urgent/emergent situations per protocol
2. Completecontinued education/training requirements
3. Perform basictriage per specific office and clinical protocol procedures
4. Respects culturaland religious practices of patients
5. Maintainprofessional appearance at all times
6. Establish andmaintain effective working relationships with physicians, staff and management
7. Effectively copewith typical job stress
8. Participate inperformance improvement and continuous quality improvement activities
9. Document workprocess as required
10. Punctual anddependent for assigned/confirmed shiftsPerform other duties assigned
EDUCATION &CERTIFICATION:
A minimum of High SchoolDiploma or General Education (GED). Graduate from a vocational or collegepreferred. Knowledge in Medical Terminology a plus. Proficiency must beattained via on-the-job training and orientation.
QUALIFICATIONS, SKILLS ANDABILITIES:
The Insurance Specialist
must have a minimum of 1-3 years' experience inhealthcare scheduling, billing and collections, financial counseling in aphysician office setting preferably within the urology specialty. Customerservice skills experience is a must. Excellent oral and written communicationskills. Proficient interpersonal relations skills. Must have strong computerskills to handle clerical tasks, including working with office and EMR systems.Basic Knowledge of health insurance products (HMO, PPO, HSA, Commercial,Medicare etc.). Basic knowledge and understanding of CPT procedure coding andICD-10 diagnostic coding a plus. Physician or Hospital registration or admittingexperience is desirable.
COMPUTER SKILLS:
To perform this job successfully, an individual should havethe knowledge of: Internet Software; Word Processing Software (Microsoft Word);Electronic Mail Software (Microsoft Outlook); Electronic Health Records (EMRSoftware); Practice Management Software (iSalus)