Insurance And Billing Specialist I, Ii

Works collaboratively with KANA Scheduling and Registration Specialists (SRS), staff, providers, third party billing vendor, insurance companies, and patients to ensure accurate and current information is gathered and entered in the system in a timely manner to generate a clean bill and prompt reimbursement for all medical, dental, and behavioral health claims. Prefer interest in Alaskan Native wellness, women's health including obstetrics, addiction medicine from a risk reduction model, and leadership interest and skills.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Support the organization's mission and goals, quality standards, and patient-centered medical home philosophy. Embrace KANA's culture of serving the whole person through our provision of services.
• Incorporate KANA's core values of Courtesy, Caring, Respect, Sharing, and Pride in all activities and decisions.
• Uphold KANA's Code of Ethics by conducting professional activities with honesty, integrity, respect, fairness, and good faith in a manner that reflects positively upon the organization.

Insurance and Billing Specialist I

• Complete patient insurance eligibility and benefits verification prior to scheduled visits.
• Work collaboratively with SRS to continuously monitor clinic schedules for added encounters and ensure EHR systems reflect accurate and current insurance information.
• Note accounts and/or appointments as needed for items that may need to be reviewed or collected from the patient on the date of service.
• Facilitate prior authorization requests before scheduled visits and accommodate requests during visits as the need arises.
• Review patient schedules a minimum of two days before arrival for service to ensure each patient has had their insurance verified, authorized/preauthorized, and any payment arrangements made.
• Identify outstanding account balances prior to scheduled appointments and communicate with SRS to collect payments at time of check-in.
• Facilitate patient payment options, including establishing payment plans, and post payments as needed.
• Work with BH Compliance Specialist to identify billing trends affecting department revenue.
• Provide oversight for BH documentation nearing 72-hour deadline; review and file signed treatment plans and consents for treatment as needed.
• Provide tracking for grant-funded encounters and record exemptions in EHR appropriately.
• Manage information for psychiatry referrals and ensure they are electronically filed, prior authorizations processed, and records printed/sent prior to appointments.
• Review and maintain timely completion of assigned EHR work queues.
• Communicate effectively and appropriately with patients, colleagues, and other KANA staff.
• Practice meaningful customer service skills and address patient and staff needs courteously, promptly, and with compassion and applying charitable assumption.
• Other duties as assigned.

Insurance and Billing Specialist II

• Includes all duties and responsibilities of Specialist I, plus:
• Respond to requests for information from third party billing vendor promptly to support timely coding and submission of claims.
• Manage aged patient accounts by collaborating with third party billing vendor, KANA staff, and patients to troubleshoot billing questions and concerns in a timely manner.
• Contact patients with reminders as well as payment options, and coordinate with Patient Benefit Coordinator to explore alternative resource options.
• Review the payment log daily for accuracy of patient payments made on the date of service (co-pays, deductibles, coinsurance, etc.) and update information on current or aged accounts as needed. Coordinate reimbursement activities with third party billing vendor and payors by researching denied claims and resolving discrepancies to ensure proper processing and payment.
• Act as a resource for Providers who may have questions regarding service coverages, patients' financial
• responsibilities, patient potential costs, etc.
• Provide tracking, oversight, review, and confirmation of proper documentation practices for preauthorization activities.
• Attend trainings, meetings, and user group calls as assigned by the Revenue Cycle Director.
• Serve as primary point of contact and liaison for VA communications and requests, and train Specialist I staff to provide consistent back up coverage in this capacity.
• Assist with training and provide support to Insurance and Billing Specialist I staff.

Supervisory Responsibilities This job has no supervisory responsibilities.