HealthCore Clinic

Insurance and Reimbursement Representative  (Full Time)
Department:: Billing

 Title:                             Insurance and Reimbursement Representative (ll)

Position Reports To:      Revenue Cycle/Billing Manager

Department:                  Finance   

Exempt Status:             Non-Exempt

At Healthcore Clinic, we believe healthcare is a human right whose access should not be bound by finances.  If you believe in our philosophy and are fun loving, open minded, caring and flexible with your schedule, then you have come to the right place.  We are people serving people, serving people. We are looking for dynamic individuals to join our family at Healthcore Clinic.

Summary:

Strong billing and insurance follow-up knowledge is required as well as the processing of electronic claims and payments. This position will assist with working denials and following up on unpaid insurance claims. The position will work with patients in resolving patient account issues and resolving unpaid balances as needed. The position will also work with medical, dental, and behavioral health provider types in an integrated healthcare environment. This position requires an individual who is friendly, detail oriented, has excellent communication skills, can multi-task and organize work effectively, and has the ability to work independently and as a cooperative team member. HealthCore serves a culturally diverse community that is negatively impacted by multiple social determinants of health factors.

Job Description:

Processes all insurance claims accurately to ensure a timely return of payment. Work rejections and denials, resubmitting claims, filing appeals and providing additional information to substantiate claims information as needed. Process payments and denials from insurance companies both electronically and manually. Prepare, review and send patient statements. Manage patient inquiries, identify and resolve patient billing issues. Provide patient financial counseling, support enrollment/referral of patient to potential insurance programs for coverage, and collection of patient balances.

Patient-Centered Medical Home Job Responsibilities:

1.     Patient Population Management:

a.     Verify insurance and assist patients in understanding coverage

b.     Assist in verifying accuracy of claims and patient bills

2.     Care Coordination:

a.     Assist with referring patients to potential programs to assist with gaining insurance coverage for services.

3.     Communication Skills:

a.     Excellent interpersonal and organizational skills are required, including the ability to multi-task and adapt to a changing work environment. Display good judgment and decision making skills.

b.     Ability to establish and maintain effective working relationships with other administrative and clinical staff, and the public.

c.     Display professional appearance in accordance with HealthCore Clinic’s (HCC) policies.

4.     Quality Improvement:

a.     Support quality improvement pay for performance reimbursement initiatives provided by insurance companies.

Job Functions:

·         Prepares and submits claim files to various insurance companies through the clearinghouse either electronically or by paper.

·         Validate patient insurance policies and demographics.

·         Work claim edits and insurance denials, issuing adjusted, corrected and/or rebilled claims. Filing appeals as needed.

·         Engage with insurance representatives to identify and resolve issues in claims processing.

·         Handle patient inquiries. Identifies and resolves patient billing issues and balances.

·         Prepare, review and send patient statements.

·         Work with patients on unpaid balances; setting up payment plans and validating if they meet qualifications for discounted services.

·         Review accounts and make recommendations to management regarding non-collectible accounts.

·         Process payments and denials from insurance companies either electronically or manually.

·         Process patient payments.

·         Reconciling posting of payments with finance department.

·         Stay current on billing and insurance guidelines and requirements.

·         Participates in educational opportunities.

·         Maintain strictest confidentiality, and adheres to all HIPAA guidelines/regulations.

Qualifications:

• Associate’s degree or equivalent from two-year college or technical school; 6-10 years related experience and/or training; or equivalent combination of education and experience.
• ICD-10, CPT and medical terminology knowledge.
• Comprehensive understanding of medical insurance is required.
• Experience in Electronic Medical Records/Electronic Health Records (EMR/EHR) and general medical, dental, and/or behavioral health billing procedures.

• Knowledge of basic arithmetic to make calculations, balance and reconcile figures, and make changes accurately.
• Excellent communication skills, both verbally and in writing.
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Working Conditions/Physical Demands: 

Works in a well-lit, climate controlled environment. Repetitive movement-requires repetitive hand and finger movement, keying information into the computer.  Regularly required to sit and work at computer monitor.  Ability to lift up to 20 pounds. Occasionally required to stand, walk, reach with hands and arms, climb or balance, stoop, kneel or crouch.