The Insurance Billing Specialist is responsible for preparing, submitting, and following up on insurance claims to ensure timely and accurate reimbursement for services provided by Utah Valley Pediatrics. This role requires a solid understanding of medical billing processes, insurance policies, and pediatric coding. The specialist works closely with insurance companies, patients, and internal departments to resolve claim issues and maintain a smooth revenue cycle.

Essential Behaviors and Characteristics:

• Exhibits a caring, positive, and cheerful attitude; is adaptable, positive and supportive, even during stressful situations.
• Treats everyone with the utmost respect and courtesy. Recognizes and supports the contributions of others, and shows patience and kindness in helping others as they learn and grow. Speaks positively and respectfully of others.
• Is honest in all of their dealings. Stays on task and uses time at work to benefit patients, coworkers, providers, and the company as a whole. Their actions reflect positively on Utah Valley Pediatrics.
• Responds promptly to the needs of others and looks for ways to help and serve.
• Offers exceptional customer service with every interaction, actively seeking opportunities to give positive, memorable service. Listens carefully and thoughtfully, and works collaboratively to help anyone in need.

Required Skills:

• Customer Service: Ability to handle irate customers. Able to defuse rather than add to tense situations. Communicates with customers clearly and helps them understand what their obligations and responsibilities are. Maintains professionalism under pressure. Willing to go the extra mile to help customers resolve account or claim issues.
• Attention to Detail: Accuracy in work. Follows through completely on account issues.
• Self-starter: Ability to prioritize and manage multiple responsibilities. Can make judgement calls based on knowledge of set policies and procedures. Motivated to stay on task with little supervision.
• Basic Computer Applications: Proficient in keyboard; knowledge of Word, Excel, Outlook and internet functions.
• Communication: Ability to read, understand and follow written and oral instructions. Ability to clearly communicate needs, instructions, concerns, etc. with others.
• Office Equipment: Basic knowledge of standard office equipment such as copiers, fax, printers, etc.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO:

• Return billing voice-mail messages
• Timely posting of assigned miscellaneous payments
• Timely posting of assigned electronic insurance payments
• Track contracted allowable amounts
• Resolve unpaid or incorrectly paid claims in a timely manner (immediately when possible) through tracing program, insurance EOBs and patient phone calls
• Inform billing manager of any contractual or payment issues immediately
• Correctly process credit card transactions, and correctly record and store all credit card and cash payments
• Answer phone calls and resolve patient questions or concerns
• Participate in studies that will help improve overall job performance as they relate to billing processes
• Help track and manage office supplies
• Filing
• Keep office and personal areas organized and neat

PHYSICAL AND MENTAL DEMANDS:

• Ability to sit for 7-8 hours a day
• Ability to use a keyboard and 10-key for 7-8 hours a day
• Some lifting (20-50 lbs.) may occasionally be required
• Occasional stress related to workload and customer problems

NECESSARY QUALITIES:

• Able to create and contribute to a pleasant office atmosphere
• Able to maintain medical and financial confidentiality
• Friendly and caring nature which keeps communication lines open
• Ability to maintain cooperative relationships with customers, physicians, co-workers and management staff
• Ability to follow and support existing policies and procedures. Willing to go through appropriate channels with suggestions for change.
• Strong desire to be helpful with both customers and co-workers
• Prior experience with E.H.R a preference.

WE PROVIDE TRAINING ON THE FOLLOWING:

• Medical management software
• Medical terminology; as related to position.
• Medical coding; as related to position.
• HIPAA
• Utah Valley Pediatrics Policy and Procedure
• Insurance billing

EDUCATION AND EXPERIENCE:

• High School diploma
• Experience in the Medical field is helpful but not necessary
• Experience in the Billing field is helpful but not necessary
• Must attend any training opportunities provided by Utah Valley Pediatrics