MEDICARE INSURANCE SPECIALIST

JOB SUMMARY: Under the Supervision of the Business Office Manager is responsible for the timely submission of claims as well as accurate follow-up of claims submitted to SPECIFICALLY MEDICARE insurance payers. Responsible for notifying Governmental payers of all overpayments per Federal guidelines. Will assist the provider office(s) with any requested benefit verifications. Will keep current of all assigned payer newsletters and bulletins.

DUTIES & RESPONSIBILITIES:

1. Responsible for ensuring the timely filing of insurance claims through the use of the claim edit work queue as well the follow-up 277 payer rejection work queue.
2. Responsible for follow–up of insurance claims through the use of payer web sites, portals, and other mechanisms as directed by management.
3. Responsible for general knowledge of payer rules and contract guidelines and billing procedures in order to accomplish follow-up activity.
4. Responsible to keep current on all assigned payer newsletters and bulletins for medical or administrative policy changes and communicating said changes to the Special Projects Coordinator, Business Office Manager, or designee.
5. Responsible for review and correction of denied claims in accordance with rules and regulations both Federal and payer specific.
6. Responsible for notifying/refunding all governmental overpayments within 60 days of identifying said overpayment.
7. Will assist the Collection Unit in answering patient inquiries.
8. Performs other office duties as assigned.
9. May be exposed to hazardous drugs.
10. Attends OSHA training upon initial employee orientation and annually completes an OSHA competency.

RELATIONSHIP WITH OTHERS: Must interact well with providers and clinical staff as well as payer staff and the staff and management in the Business Office. Must exhibit a high degree of attention to detail.

EDUCATION/EXPERIENCE/KNOWLEDGE: Graduated from High School or completed GED requirements. At least 5 years of Medicare billing experience required.

PHYSICAL REQUIREMENTS: Requires sitting, standing, bending, and reaching. May require lifting up to 20 pounds. Requires manual dexterity sufficient to operate office equipment such as computer, fax, calculator, and telephone. Requires normal hearing and vision.