Insurance Coordinator

A. GENERAL SUMMARY OF DUTIES

Responsible for reviewing, processing and investigating insurance claims to assure receipt of maximum reimbursements available.

B. ESSENTIAL DUTIES

Investigates a large volume of denied claims to discover errors that may have caused denial, makes corrections and resubmits claims. Errors may include incorrect procedure coding, incorrect insurance information, technical difficulties in electronic billing systems. Works mainly with an assigned group of insurance providers. Coordinates benefits between primary and secondary insurance providers. Processes incoming checks and posts charges to patient accounts. Reviews monthly accounts receivable aging reports, re-bills patients as necessary. Complies with clinic policies and procedures on regular work attendance.

C. OTHER DUTIES

Communicates with patients and insurance companies via the telephone to effectively resolve account questions and complaints and to clarify insurance coverage. Occasionally meets with patients in person. Investigates changes in insurance coding or policies through review of web-sites, manuals, newsletters and attending meetings. Applies changes as appropriate based on information gathered. Educates co-workers on changes when necessary. Prepares miscellaneous correspondence to insurance companies such as letters of medical necessity, orders for physical therapy. Verifies demographic and insurance information for outreach patients. Takes payments on accounts either in person or over the phone. Provides back-up to switchboard operator and other business office personnel as needed, which may include answering phones, opening mail, and other miscellaneous duties.

D. EDUCATION

High School diploma or

GED. E. EXPERIENCE

Three to five years experience in medical business office, with an emphasis in insurance reimbursement procedures.

F. KNOWLEDGE, ABILITIES AND SKILLS

Knowledge of basic insurance processing and claims resubmission procedures. Knowledge of basic medical terminology and coding. Ability to work with a high level of attention to accuracy and detail. Ability to work independently to investigate and resolve insurance denials in a timely manner. Ability to prioritize work and multi-task in a fast-paced environment. Ability to read, understand and follow written and oral instructions. Skills in using mathematical calculations to review patient accounts. Skills in using customer service principles to work cooperatively with patients in order to resolve questions and discrepancies. Skills in using computer (approx. 40 wpm), ten key calculator and other office machines. Skills in oral and written communication.

G. ADDITIONAL POSITION REQUIREMENTS

The job holder must demonstrate current competencies applicable to the job position. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. Must pass a background check