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Health Insurance Specialist, Edi Registration Specialist & Credentialing Coordinator
Posted: 01/07/2020
Position: Full Time
About This Job:
***GREAT COMMAND OF ENGLISH - TOP PERFORMER - MUST HAVE EXPERIENCE WITH USA INSURANCES***
 
•Enters information necessary for insurance claims such as a patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Ensures that claim information is complete and accurate.
 
•Submits insurance claims to the clearinghouse or individual insurance companies electronically or via a paper CMS-1500 form.
 
•Answers patient questions on patient-responsible portions, co-pays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered.
 
•Post insurance and patient payments using medical claim billing software.
 
•For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by the primary insurer.
 
•Follow up with the insurance company on unpaid or rejected claims. Resolves issues and resubmits claims.
 
•Prepares appeal letters to insurance carriers when not in agreement with a claim denial. Collects necessary information to accompany the appeal.
 
•Prepare patient's statements for charges not covered by insurance. Ensures that statements are mailed on a regular basis.
 
•Provide necessary information to collection agencies for delinquent or past due accounts.
 
•May work with patients to establish a payment plan for past due accounts by provider policies.
 
•May perform “soft” collections for past due accounts. The soft collections may include contacting and notifying patients via phone or mail.
 
•Follows HIPAA guidelines in handling patient information.
 
•May periodically create insurance or patient aging reports using medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts.
 
•Understand managed care authorizations and limits to coverage, such as the number of visits. We encounter these cases mostly when billing for specialties.
 
•May have to verify eligibility and coverage for patient benefits.
 
•Ability to look up ICD 9/10 diagnosis and CPT treatment codes from online service or using traditional coding references.
 
•Must have experience working with USA Insurances.
 
•Enters information necessary for insurance claims such as the patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Ensures that claim information is complete and accurate.
 
•Submits insurance claims to the clearinghouse or individual insurance companies electronically or via a paper CMS-1500 form.
 
•Answers patient questions on patient-responsible portions, co-pays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered.
 
•Post insurance and patient payments using medical claim billing software.
 
•For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by the primary insurer.
 
•Follow up with the insurance company on unpaid or rejected claims. Resolves issues and resubmits claims.
 
•Prepares appeal letters to insurance carrier when not in agreement with a claim denial. Collects necessary information to accompany the appeal.
 
•Prepare patient statements for charges not covered by insurance. Ensures statements are mailed on a regular basis.
 
•Provide necessary information to collection agencies for delinquent or past due accounts.
 
•May work with patients to establish a payment plan for past due accounts under provider policies.
 
•May perform “soft” collections for past due accounts. May include contacting and notifying patients via phone or mail.
 
•Follows HIPAA guidelines in handling patient information.
 
•May periodically create insurance or patient aging reports using medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts.
 
•Understand managed care authorizations and limits to coverage, such as the number of visits. This is encountered often when billing for specialties.
 
•May have to verify eligibility and coverage for patient benefits.
 
•Ability to look up ICD 9/10 diagnosis and CPT treatment codes from online service or using traditional coding references.
 
EDI Enrollment Job Summary
Enrollment Specialist and Onboarding: New Install - This representative is responsible for gathering registration, completing EDI agreements and working with our clients, vendors, payers, and assigned MediTouch or ClaimMD Implementation Team to ensure enrollment is complete for the client at the time of going live. And, keep enrolling the providers for EDI transactions as long as needed.
Key Responsibilities:
 Understand customer needs and setup requirements based on account types (i.e., physician group, surgery center, lab, etc.), the number of Tax ID’s, NPIs, the mix of payers, etc.
 Ensure registration is received and completed thoroughly and on time.
 Generate, monitor, and follow up on EDI agreements meeting specific implementation deadlines.
 Monitor accounts for rejections or issues specific to enrollment-related items throughout the client’s implementation.
 Maintain up to date and accurate documentation of the account throughout the implementation process.
 Follow documented HIPAA security procedures related to Protected Health Information (PHI) and financial information.
Roles & Responsibilities:
We are looking for a full-time, goal-oriented, revenue-driven, highly accurate and motivated person. With:
 
§Strong organization skills and attention to detail.
 
§Excellent communication skills (over the phone and electronic)
 
§Shows initiative to accomplish tasks.
 
§Ability to establish and maintain effective working relationships with clients, co-workers, supervisors, and managers.
 
§Ability to be a problem solver and team player to thrive in a fast-paced environment.
 
Collect and enter claim information. Post insurance and patient payments and manage accounts. Submit claims and follow up with insurance carriers on unpaid or rejected claims. Answer patient inquiries on account status and charges. Report to the billing supervisor.
Requirements & Qualifications:
Must have experience working with USA Insurances.
 
•Enters information necessary for insurance claims such as the patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Ensures that claim information is complete and accurate.
 
•Submits insurance claims to the clearinghouse or individual insurance companies electronically or via CMS-1500 form.
 
•Answers patient questions on patient-responsible portions, co-pays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered.
 
•Posts insurance and patient payments using medical claim different billing software.
 
•For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by the primary insurer.
 
•Follows up with the insurance company on unpaid or rejected claims. Resolves issues and resubmits claims.
 
•Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collects necessary information to accompany the appeal.
 
•Prepares patient statements for charges not covered by insurance. Ensures statements are mailed on a regular basis.
 
•Provides necessary information to collection agencies for delinquent or past due accounts.
 
•May work with patients to establish the payment plan for past due accounts in accordance with provider policies.
 
•May perform “soft” collections for past due accounts. This may include contacting and notifying patients via phone or mail.
 
•Follows HIPAA guidelines in handling patient information.
 
•May periodically create insurance or patient aging reports using medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts.
 
•Understand managed care authorizations and limits to coverage, such as the number of visits. This is encountered often when billing for specialties.
 
•May have to verify eligibility and coverage for patient benefits.
 
•Ability to look up ICD 9/10 diagnosis and CPT treatment codes from online service or using traditional coding references.
Skills Required:
Customer Service
Chat Support Level 5
Technical Support Level 5
Email Support Level 5
Phone Support Level 5
Customer Support Level 5
Administrative Support
Medical Billing Level 4