Insurance Specialist Lead

HOURLY RATE (DEPENDING ON SKILLS/EXPERIENCE): $24.78 - $38.13

SCOPE: Responsible for providing strong technical/subject matter expertise and knowledge to AR team. This position will also function to assist the Revenue Cycle Manager and/or AR Supervisor in areas of workflow, staffing and day-to-day operations. The Lead will assume the responsibilities of the Supervisor in his/her absence and assist the Supervisor with training and employee performance appraisals.

RESPONSIBILITIES:

• Support the revenue cycle operations of the organization and serving as a subject matter expert. Monitor and proactively resolve outstanding accounts receivables; including high dollar accounts, credit balances, payer issues and trends.
• Monitor the flow of incoming phone calls, correspondence and messages - voice/email - and ensure patients receive timely responses. Assists A/R reps with daily activities, training, escalated calls, billing issues and work with Supervisor to determine outlined course of action.
• Assist with team meetings, monitoring continuing education opportunities and disseminating learned information to downstream teams.
• Assist Supervisor with new and ongoing unit projects and related reporting, daily, weekly, monthly or as needed.
• Provide support and mentoring on an as needed basis to leadership regarding any feedback on tardiness, attendance, performance and productivity.
• Research root causes and initiate claims resolution in the billing system with knowledge of the upstream and downstream impact of work. Maintains timely follow-up on outstanding insurance claims in appropriate EPIC WQs, ensuring claims are billed/rebilled within carrier filing limits.
• Informs Supervisor of problems related to insurance company payments/denials, contract pricing, and works with Supervisor and all parties involved to ensure prompt resolution.
• Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues, Investigate and resolve all insurance payments that deviate from expected payment (i.e.: underpayments, contracting issues).

MINIMUM QUALIFICATIONS:

• GED / Diploma - High School required
• 5 years - Billing in Medical Office / Hospital experience required
• 3 years - EPIC EMR experience requred
• 5 years' experience working AR and Denial Management in Healthcare, 3 Years EPIC Experience, 2 years DOFR experience with training capability required
• Basic leadership skills, with some experience in a team setting preferred
• Basic working knowledge of full revenue cycle including but not limited to payment posting, financial ledger management, charge capture, authorization requirements, reimbursement analysis, patient benefits, payer escalations and issue tracking. preferred

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The position requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. The position requires standing and walking for extensive periods of time. The employee occasionally lifts and carries items weighing up to 40 lbs. The position requires corrected vision and hearing to normal range. WORK ENVIRONMENT The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.