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Insurance Resolution Specialist Job in Ogden, Utah

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Job Title: Insurance Resolution Specialist

Employer:Ogden Clinic
Type: Full-Time,
Skills:Insurance Billing,Insurance Claims,Customer Service,Patient Accounts
Required Certifications:High School Diploma
Location:1100 E Country Hills Dr, Suite 305,Ogden 84403, UT, US
Date Posted:11/12/2020

GENERAL SUMMARY:

Under the direct supervision of the Coding Manager, the Insurance Resolution Specialist is responsible for all issues relating to patient accounts receivable.

GENERAL RESPONSIBILITIES:

1. Provides professional and courteous service to all “customers” of the coding department. Customers include all patients of Ogden Clinic and its affiliates, administration, employees, co-workers, insurance company representatives, and all other vendor representatives.
2. Accountable for meeting behavioral expectations, and supporting the dignity of all persons. Also responsible for the stewardship of resources.
3. Ensures applicable regulatory requirements are complied with and follows guidelines that maintain safety for oneself, patients, visitors, and co-workers.
4. Responsible to study and follow all clinic Policies and Procedures.
5. Responsible to maintain an adequate level of productivity as defined with the Coding Manager.

ESSENTIAL JOB FUNCTIONS:

1. Contacts insurance companies, patients, and other third party payers regarding claim status and payment.
2. Responds to correspondence from insurance companies, patients, and other third party payers in a professional and timely manner.
3. Identifies and routes information needs to other departments within the clinic.
4. Refiles/Rebills claims as necessary, ensuring that all information contained on the claim is accurate and complete.
5. Answers incoming phone calls from patients and/or third party payers. This must be done in a timely, courteous, and professional manner.
6. Identifies and reprocesses claims requiring appeal and/or further review.
7. Works with patients to resolve outstanding insurance and/or patient balances.

OTHER DUTIES:


1. Assists with special projects as assigned.
2. Maintains confidentiality of patient records and employee/co-worker information.
3. Responsible to study and utilize the eClinicalWorks PM system to improve use and knowledge of the system’s capabilities.

QUALIFICATIONS:

1. EDUCATION: Level 3: High School Diploma or general education degree (GED).
2. LANGUAGE SKILLS: Level 3: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, procedure manuals, EOB’s, and Insurance Claims forms. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
3. At least 1 year of medical office billing and collections experience preferred.
4. Must be able to manage multiple tasks simultaneously.
5. Computer knowledge with experience in basic word processing and spreadsheet programs is helpful.
6. General office equipment knowledge helpful.
7. eClinicalWorks system use and knowledge helpful.

CHARACTERISTICS:

1. Must maintain a positive “can-do” attitude.
2. Must be willing to effectively participate as a team member with the Business Office and practices.
3. Must be committed to the protection of confidential information, records, and/or reports.
4. Must have the ability to communicate effectively in a professional and courteous manner.
5. Must have good organizational skills.

ENVIRONMENTAL FACTORS:

1. Requires prolonged sitting.
2. Requires some bending, stooping, lifting, and stretching for files and supplies.
3. Requires manual dexterity sufficient to operate a keyboard and other office equipment.
4. Must possess all physical abilities necessary to perform the job.
5. Noise level is moderate with the constant noise of business office computers, printers, telephones, etc.

DISCLAIMER CLAUSE:


The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.



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