Insurance Coordinator at Carolina Health Specialists – Myrtle Beach, South Carolina

INSURANCE COORDINATOR needed for busy medical practice in Myrtle Beach. Remote position. Must have excellent computer and customer service skills. Hours are MON.-THURS. 7:45AM-5:15PM; FRI. 8:00AM-12:00PM. No nights or weekends! Excellent pay and benefits including paid holidays, PTO and sick time, medical, dental, vision, short& long-term disability, employee assistance program, company paid life insurance, pre-paid legal, identity theft, pet insurance, and 401k offered.

GENERAL SUMMARY OF DUTIES: Responsible for payment of claims using established Central Billing Office policies and procedures. Work unpaid/denied claims by payers. Review and work paid claims for reimbursement accuracy. Interact with office/clinical staff, patients and healthcare plan representatives in regard to these claims.

TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time and working in office environment. Some bending and stretching required. Working with telephone and computer required. Manual dexterity required for use of calculator, mouse and computer keyboard.

TYPICAL WORKING CONDITIONS: Normal office environment.

EXAMPLES OF DUTIES: (This list may not include all of the duties assigned.)

1. Researches all outstanding claims through the claims worklist in Athenanet to include but not limited to: ‘Hold’, ‘Manager Hold’ and ‘Fully Worked Receivables’
2. Acts as resource to physicians and office staff on insurance payer payment policies and procedures.
3. Ensures timely response from payers of assigned claims.
4. Researches correspondence and refund/recoupment requests from insurance carriers in timely manner and makes sure payer contract language is followed by both parties.
5. Responds to all claim denials for research and appeal according to CBO policies and procedures through reviewing medical records, reviewing for supporting documentation and following the payers’ appeal process for adjudication adjustment.
6. Brings problems to the attention of supervisor.
7. Assists with answering patient questions regarding their specific insurance plan.
8. Implements special projects with payer representatives as needed for proper processing of claims to target specific problems.
9. Participates in educational activities.
10. Maintains strictest confidentiality abiding by HIPAA regulations.
11. Performs related work as required.

JOB REQUIREMENTS:

Knowledge, Skills and Abilities:

1. Knowledge of billing procedures, insurance policy and procedures and outpatient office/clinical operating policies and procedures.
2. Skill in using computer and calculator.
3. Ability to examine documents for accuracy and completeness.
4. Ability to prepare records in accordance with detailed instructions.
5. Ability to work effectively with co-workers and patients.
6. Ability to communicate clearly.

Education: High school diploma or GED

Experience: Two years experience in healthcare organization. One year of experience directly involving third payers and insurance companies.

Certificate/License: CPC-A or CPC through AAPC preferred but not pre-requisite.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as need evolves.