Insurance Specialist I

Description:

POSITION SUMMARY

The NCMS Insurance Specialist is responsible for interpreting and verifying coverage for our patients; maintaining correct insurance information on patient accounts; as well as re-billing denials. The Insurance Specialist will work within the scope of responsibilities as dictated below with guidance and support from our Insurance & Billing leadership teams.

ESSENTIAL FUNCTIONS

• Reviews, verifies, and interprets Medicare Eligibility Report to determine best coverage through medical or pharmacy benefit.
• Conducts outbound calls to insurance companies and determines if patient will be serviced thru DME or pharmacy. Contacts patients if additional insurance information is needed.
• Performs test claims to determine copayments and verify preferred products.
• Pursues prior authorizations as determined by health plan or medical group requirements.
• Maintains detailed records in company database; ensures patient primary insurance is accurate and entered in the appropriate system; documents all insurance information into each account, including patient copayments and deductible amounts.
• Verifies insurance.
• Handles all inbound calls from patients and insurance companies regarding any payments made from the insurance company.
• Resolves all denials and processes appeals for all private insurances and some Medicare patients.
• Submits all required documentation to appropriate insurance providers.
• Bills orders corresponding to a denial or change to a patients’ accounts.
• Achieves maximum reimbursement for services provided.
• Rebills claims to insurance companies via paper or electronically.
• Contacts insurance companies to obtain claim status.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback as to improve processes and policies.
• Attends all department, team, and company meetings as required.
• Embraces and exemplifies ADS core values:
• We grow together
• We care
• We obsess over the customer experience
• We commit
• We WOW!

OTHER RESPONSIBILITIES

• May perform any additional responsibilities or special projects as required.

• Duties and responsibilities may be subject to change based upon the needs of the department.

Requirements:

MINIMUM REQUIREMENTS

• High School diploma or equivalent
• Knowledge of insurance verification and/or authorization, billing and processing claims
• Basic knowledge of billing guidelines and resources for Medicare and Private insurances
• Basic knowledge of insurance portals; familiarity with a variety of medical and/or insurance terms or practices
• Proficiency in basic math and business calculations
• Working knowledge of computer/data entry with the ability to learn new systems
• Basic level of MS Office proficiency

EXPECTED COMPETENCIES

• Friendly, professional and effective communications skills; able to calmly present solutions in challenging situations
• Effective interpersonal skills
• Clear diction and knowledge of the English language, both written and verbal
• Service-orientation and aptitude to resolve insurance and/or patient matters
• Self-directed accountability and reliability
• Cultural competence

PHYSICAL DEMANDS

The physical demands described below 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 employees with disabilities to perform the essential functions.

While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

OTHER REQUIREMENTS

• Candidates must successfully pass a background check.
• Candidates must be able to provide proof of eligibility to work in the United States without support; sponsorship is not available.