EO, Client Operations Insurance Specialist

Insurance Claims Processor

Process and manage insurance claims for patient accounts, ensuring all claims are billed accurately and in a timely manner.

Follow up on unpaid claims and outstanding balances, ensuring efficient resolution of billing issues and discrepancies.

Manage all open agent tickets relating to insurance inquiries through completion.

Post any missing payments to accounts through RP function for client reconciliation process (insurance project clients).

Provide feedback to Management on any issues concerning call center behavior as it relates to agent tickets.

Provide feedback to Management on any client issues in time for scheduled client meetings.

Take initiative and action to respond, resolve and follow up regarding customer service issues and client requests in a timely manner.

Meet deadlines with frequent interruptions and redefined priorities.

Communicates all feedback, client updates, and recommendations to all levels within the organization using professionalism, positive attitude, and discretion to achieve objectives.

Work all accounts that have been billed to insurance for their assigned clients through completion.

Meet all out of guideline requirements set forth by department leadership.

Ensure all accounts have been billed in HOST system by designed payer requirement dates for prompt payment.

Ensure all accounts referred back to client are followed through until completion prior to designed payer requirement dates for prompt payment.

Meet deadlines with frequent interruptions and redefined priorities.

Knowledge, Skills, and Abilities :

Experience with various on-government insurances.

Experience with claim edits.

Denials and insurance follow up.

Efficient in Microsoft Office products, especially Excel and Word.

Knowledge and understanding of diagnosis, HCPCS and CPT codes.

In-depth understanding of remittance advice, electronic billing reports, and claims resolution.

Extensive knowledge of medical billing, insurance processes, managed care, and payer guidelines.

Understanding of legal rules and regulations pertaining to billing, collections, and HIPPA.

Ability to work independently while also contributing to team success and organizational goals.

Active Listening Giving full attention to what others are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

Reading Comprehension Understanding written sentences and paragraphs in work related documents.

Speaking Talking to others to convey information effectively.

Service Orientation Actively looking for ways to help people.

Writing Communicating effectively in writing as appropriate for the needs of the audience.

Coordination Adjusting actions in relation to others' actions.

Time Management Managing one's own time and the time of others.

Social Perceptiveness Being aware of others' reactions and understanding why they react as they do.

Monitoring Monitoring / Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.

Active Learning Understanding the implications of new information for both current and future problem-solving and decision-making.

Critical Thinking Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

Judgment and Decision Making Considering the relative costs and benefits of potential actions to choose the most appropriate one.

English Comprehension The ability to fluently communicate in and understand English, the primary language of the work team.

Written Comprehension The ability to read and understand information and ideas presented in writing.

Written Expression The ability to communicate information and ideas in writing so others will understand.

Oral Comprehension The ability to listen to and understand information and ideas presented through spoken words and sentences.

Oral Expression The ability to communicate information and ideas verbally so others will understand.

Speech Recognition The ability to identify and understand the speech of another person.

Speech Clarity The ability to speak clearly so others can understand oral communication.

Problem Sensitivity The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.

Inductive Reasoning The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).

Selective Attention The ability to concentrate on a task over a period of time without being distracted.

Category Flexibility The ability to generate or use different sets of rules for combining or grouping things in different ways.