Insurance Team Lead

Position responsibilities

• Review accounts placed as self-pay to determine if insurance coverage exists
• Analyze unpaid claims and determine reason for them to have not been adjudicated
• Contact insurance carriers to obtain status on claims and ultimately payment
• Utilize online tools to research insurance claims when available
• Obtain supporting documentation (i.e., medical records, explanation of benefits, authorizations, referrals, etc.) to submit to insurance carriers
• Submit appeals in proper format when appropriate
• Review, interpret and apply contractual terms
• Contact patients/ guarantors to facilitate and expedite processing of their claims when needed
• Assist with other duties as related to the special projects
• Perform job duties in accordance with the organization's information security policies
• Protect assets from unauthorized access, disclosure, modification, destruction or interference
• Individual accountability
• Report security events or potential events or other security risks through the incident reporting procedures
• Monitor inventory to ensure all claims are within compliance timelines
• Provide reporting to management showing open inventory and potential recovery
• Other duties as assigned

Education and experience

• 7 years’ experience in a facility setting performing insurance follow-up/ denials management
• Knowledge of UB04/CMS 1450 and CMS 1500 claim forms, EDI, HCPCS, ICD-9/ ICD-10, CPT, DRG’s and ability to interpret an Explanation of Benefits
• Complete working knowledge of billing instructions and procedures for each payer source according to regulations and guidelines
• Knowledge of Commercial, Governmental and third-party denials and appeals processes
• Knowledge of billing systems
• Must have effective organizational skills and a high attention to detail
• Medical terminology required
• Must demonstrate the ability to adapt to change, maintain professionalism in challenging situations, and work in a Business professional environment
• Medi-Cal knowledge a major benefit
• High school diploma or college degree from an accredited college or university

Work environment / physical requirements

• Work environment is an office location. The position requires the dexterity to operate office equipment such as a personal computer, keyboard, mouse and telephone
• Occasional lifting may be required up to 25 lbs.
• Must be able to sit for extended periods of time with frequent bending and stooping

Additional Notes

• This role profile is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities or working conditions associated with the position.
• Must possess the ability to work independently, have excellent customer service and communication skills, patience, flexibility, and the ambition to achieve goals. Fast paced environment with multiple facilities.

GetixHealth is an equal employment opportunity employer.