Insurance Specialist

Summary: An Insurance Specialist is responsible for working and managing Accounts Receivable for our Clinic and Surgery Center and providing excellent customer service to our patients.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

1. Maintains comprehensive understanding of insurance rules, regulations, and payer contract requirements.
2. Monitor Insurance Accounts Receivable for both our Clinic and Surgery Center by following up on unpaid or denied insurance claims while adhering to insurance carrier guidelines, file/refile and/or appeal claims to obtain maximum reimbursement, and work credit balances in a timely manner.
3. Answer inquiries from insurance carriers and patients via mail or telephone.
4. Process patient payments received via mail or telephone.
5. Coverage of phone line for incoming Insurance Team calls.
6. Update demographic information in the system .
7. Cross-train on functions within Patient Accounts to help provide coverage occasionally as requested.
8. Follow all policies and procedures of the organization and department.
9. Participate in the development of department policies and procedures.
10. Handle other projects as assigned.
    

Education/Experience:

1. High school diploma or equivalent.
2. One or more years' medical billing and/or insurance experience required.
3. One or more years' experience balancing accounts and handling payments required.
4. Ability to make sound judgments according to procedures or acceptable recommendations for exceptions when needed.
5. Current knowledge of insurance reimbursement structure

Qualifications:

1. Excellent interpersonal skills to build effective partnering relationships with internal departments.
2. Excellent communications skills both written and verbal.
3. Ability to work on variety of projects accurately and within timelines.
4. Microsoft Excel and Word experience
5. Valid WI Driver's License

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; sit; use hands to type; and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch and bend. The employee must occasionally lift and/or move boxes up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.


Essential Physical Requirements

Codes:
N = Never
O = Occasional, represents 1 to 33% or 1 to 2 hours of an 8 hour workday.
F = Frequently, represents 34 to 66% or 2½ to 5½ hours of an 8 hour workday.
C = Continuously, represents 67 to 100% or 6 to 8 hours of an 8 hour workday.

PHYSICAL ACTIVITY

Walking: O

Standing: O

Sitting: C

Reaching Shoulder Height: O

Reaching Above Shoulder Height: O

Reaching Below Shoulder Height: O

Climbing: N

Pulling 25 Pounds or Less: N

Pulling 25 Pounds to 50 Pounds: N

Pulling Over 50 Pounds: N

Pushing 25 Pounds or Less: N

Pushing 25 to 50 Pounds: N

Pushing Over 50 Pounds: N

Lifting 25 Pounds or Less: N

Lifting 25 Pounds to 50 Pounds: N

Lifting Over 50 Pounds: N

Carrying 25 Pounds or Less: N

Carrying 25 Pounds to 50 Pounds: N

Carrying Over 50 Pounds: N

Crawling/Kneeling: N

Bending: O

Twisting/Turning: O

Balance: N

PHYSICAL EXPOSURE

Unprotected Heights: N/A

Lighting Bright: YES

Lighting Dim: N/A

Mechanical Hazards: N/A

Hazardous Substance: N/A

Infectious Diseases: N/A

Harmful Physical Agents (Heat/Cold): N/A

Noise: N/A

Ionizing/Non-Ionizing Radiation: N/A

ACCEPTED MINIMUM PHYSICAL ABILITY

Vision: GOOD

Color Vision: IMPAIRED

Hearing: MODERATE LOSS

Manual Dexterity: GOOD

Talking/Speech: FAIR

*Note It is the Bone & Joint Clinic policy to not lift, pull/push, carry 50/50 lbs. without assistance