Lead Insurance Review Spec-Cln

Position: Lead Insurance Review Specialist

Location: St. John Outpatient Center, St. John, IN 46373

Job Summary:

Under the direction of the Insurance Review Supervisor, serves as leader for the follow-up portion of the revenue cycle. Monitors follow-up work queues and reports and initiates action where needed. Oversees and performs outstanding claim tracking, denial management, claim appeals, retro-adjudication, and reimbursement monitoring processes. Oversees and performs statement processing, self-pay follow-up, and bad debt processes. Motivates and educates staff to perform tasks according to baseline goals and objectives.

Education/ Experience Requirements:

• High School graduate (or GED equivalent).
• 1-2 years lead or supervisory experience preferred.

• 3-5 years professional/hospital billing experience required.
• Possess in-depth knowledge of medical terminology; and of the CPT, ICD-9-CM, ICD-10-CM, and HCPCS coding systems.
• Comprehension of government and third party billing regulations required.
• Must be able to utilize Microsoft office applications, perform internet navigation and research, and have prior experience using a computerized health information system.
• Needs to be familiar with operating general office equipment, including but not limited to: scanner, fax machine, photocopy machine, printer and adding machine.
• Ability to multi-task efficiently and effectively.
• Must be able to act calmly and effectively in a busy or stressful situation.
• Excellent attitude, interpersonal skills and communication abilities necessary to interact with patients, family members, physicians, and other hospital associates.
• Exhibits leadership qualities: planning, organizing, delegating, leading, teaching, etc.
• Excellent verbal and written communication; excellent problem solving abilities.