Regional Support Specialist

The Regional Support Specialist is a dedicated insurance specialist assigned to a specific region, applying expertise to the variety of third-party contracts within that region. This role oversees all steps of the patient billing process (private pay, insurance, government programs, etc.), including interfacing directly with the patient as needed. Work closely with clinics’ Patient Services Coordinators to gather patient insurance information, interpret verification of benefits, answer patients’ questions, and offer information on hearing aid insurance coverage and upgrade options. They will send completed paperwork to clinic offices for patient signature and authorization. Ensure consistency and accuracy of invoicing and payment, eliminating mistakes and reducing waste.

JOB RESPONSIBILITIES

• Ensure positive Patient Journey experience is top priority for this position.
• Obtain and handle patient insurance information in accordance with HIPPA guidelines.
• Complete all patient paperwork such as purchase agreement, superbill, delivery confirmation, etc.
• Work with vendor to correct problems for denied claims.
• Ensure claims are paid accurately.
• Address patient questions or concerns.
• Ensure process excellence and expertise in billing and document coordination
• Apply expertise in insurance billing to plans for specific region.
• Ensure all documents are loaded.
• Coordinate with vendor to bill claims using appropriate codes and modifiers.
• Track to ensure all claims are billed.
• Track aging for all sales: Private pay, insurance, and third parties.
• Coordinate with vendor on verification of benefits.
• Interpret verification of benefits using criteria such as: Is office/provider contracted and credentialed?
• What aids can office fit? What are the upgrade opportunities?
• Receive sales information from offices to enter into the system.
• Communicate with clinics about hearing aid insurance coverage and upgrade options.
• Send completed paperwork to office for patient signature at fitting.
• Other duties/responsibilities as assigned

JOB REQUIREMENTS

• High school degree or equivalent work history.
• Nice to have: Associate’s degree in Business Administration, Accounting or Health Care Administration.
• Experience (i.e. years of work experience related to the job)
  • Experience in office administration; hearing aid office experience preferred.
• Knowledge / Technical Requirements (List programs, technologies, knowledge required to perform essential job
• responsibilities)
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and
• Familiarity with CPT and ICD-10 Coding preferred but not essential.
• Knowledge of medical terminology likely to be encountered in medical claims.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996
• (HIPAA).
• At least 3 years of experience with billing/medical insurance processes.
• Preferred: Knowledge of hearing aid insurance billing processes.
• Competencies, Skills & Abilities (List additional competencies, skills, and abilities to be successful in the job, i.e. Ability to
• communicate details and requests with professionalism and accuracy)
• Competent use of computer systems and software.
• Effective communication abilities for phone contacts with insurance payers to resolve issues.
• Customer service skills for interacting with patients regarding medical claims and payments, including
• communicating with patients and family members of diverse ages and backgrounds.
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle
• conflict in a reasonable fashion.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• A calm manner and patience working with either patients or insurers during this process.

WORK CONTEXT

• Standard office conditions
• Standard office equipment

Salary and Other Compensation

The annual hourly rate for this position is between $18.51 - $23.73 per hour. Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.

Benefits

The following benefits for this position, subject to applicable eligibility requirements, include medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, short-term disability insurance, long-term disability insurance, employee assistance program, hearing aid benefits, PTO, paid sick and safe time, and paid holidays annually.

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The above declarations are not intended to be an all-inclusive list of the duties and responsibilities of the job described, nor are they intended to be such a listing of the skills and abilities required to do the job. Rather, they are intended only to describe the general nature of the job.