INSURANCE SPECIALIST

FLSA: Non-Exempt

Reports To: Silvia McDaniel

Main Function:

As a member of the care team, the Certified Coder is responsible for working collaboratively with other team members to assure the safe, timely and accurate delivery of patient care. The Insurance Specialist is responsible for the filing of insurance claims, including review of aged accounts receivable and outstanding claims reports utilizing appropriate CPT procedure and ICD-10 diagnosis codes. 

Customer Service

• Operates within the concept of patient focused care
• Anticipates patient needs
• Delivers caring, timely service with positive body language
• Presents good telephone skills
• Greets patients at every stage of the visit
• Responds promptly to patient needs requests
• Responds promptly to Physician and team member requests and inquiries
• Participates as an active, positive member of the TOI team

Insurance Specialist Duties

• Processes all insurance claims for assigned area
• Analyzes and resolves physician claim rejects and denials.
• Identifies trends/problems in billing process and presents viable solutions.
• Processes mail receipts for their respective patient types by posting payment to appropriate account, and review EOB for correct adjustment.
• Submits adjustment and refund requests with appropriate documentation.
• Reviews aged accounts receivable and outstanding reports for appropriate tracking
• Compiles monthly reports as requested
• Assists with physician billing and document training
• Performs related work, as required

Qualifications

• High school diploma or equivalent
• Three to Five years of experience in medical billing environment
• One year of work experience in a medical setting
• Knowledge of medical terminology
• Word processing and computer experience
• Must have experience creating spreadsheets, reports, and trends data

Mental/Physical Requirements

• Ability to work well under pressure with diverse groups of professionals and physicians
• Ability to communicate written and oral ideas and plan effectively
• Requires good communication and organizational skills
• Requires reasoning ability and good independent judgment
• Must be sensitive to cultural and bilingual issues

• Requires working under stressful conditions and irregular hours

• Requires working with frequent interruptions
• Requires tolerance of standing or sitting posture up to (4 hours) continuously, for a total of up to (10 hours) per (12 hours)
• Required to operate computer keyboard, mouse, and monitor for a total of up to (8 hours) per (12 hours)

Working Conditions (environmental)

• Risk of occupational exposure to blood and other potentially infectious materials (OPIM)
• Possible risk of physical injury due to moving machinery and supplies

All positions with Tucson Orthopaedic Institute are to demonstrate due care in the use and communication of patients’ protected health information. It is every employee’s principal job function to ensure patient confidentiality and failure to maintain confidentiality may, and will, result in sanction and/or discharge.

If you work well in a warm, friendly and professional atmosphere, and are driven by the opportunity to make a difference and provide outstanding customer service; submit your resume to careers@tucsonortho.com.

We offer excellent Medical benefits, Free Life insurance, Free Short-term Disability insurance, 401k Matching, Profit Sharing and a smoke and drug free environment.  EOE