Job Description

3030-Pathology - LMG - Insurance Specialist
DEPARTMENT: Billing

Successfully bills patient accounts to the appropriate insurance company for payment, reconciles insurance payment and denials, follows up with insurance companies as needed, and resolves issues regarding patient accounts.

HAZARD EXPOSURE CLASSIFICATION:

EDUCATION/EXPERIENCE REQUIREMENTS:
• High school diploma or equivalent required.
• Related computer experience, working knowledge of Microsoft Office, Word, Excel
• Minimum two years’ experience in a medical/billing office setting with a strong knowledge of insurance, managed care, Medicare and Medicaid.

JOB RELATIONSHIPS:
• Reports directly to the Director of Billing.

PHYSICAL REQUIREMENTS:
• Prolonged sitting
• Repetitive hand, wrist and shoulder motion
• Lifting up to 25 lbs. occasion-ally
• Extensive reading ,writing, talking

EXAMPLE OF WORK PERFORMED
The omission of specific statements or descriptions does not preclude management from assigning duties not listed herein if such duties are a logical assignment to the position.

ADMINISTRATIVE:
• Responsible for keying patient information into internal information system.
• Analyzes, works, and appeals denials from EOB’s and correspondence daily. Flags accounts appropriately.
• Fields patient phone calls.
• Process refunds to patients & insurance companies
• Post patient, insurance payments, adjustments & denials
• Answers patient questions on plan issues if the Patient Account Specialists are not able to resolve issues.
• Monitors and reports immediately to management on any claim submission problems.
• Participates in special projects and/or assignments as requested by Manager /Director.
• Resolve insurance claim denials

PROFESSIONAL:
• Excellent organizational skills and ability to do detailed multi-tasks.
• Ability to deal effectively and professionally with patients as well as outside vendors.
• Working knowledge of office equipment.