Insurance Coordinator - Oms Spartanburg

The Insurance Coordinator is responsible for providing excellent customer service in creating and submitting patient charges and claims to insurance companies, reviewing claims and charges for accuracy, resubmitting and/or appealing denied claims, posting payments and adjustments to patients' accounts, answering complex patient inquiries and working on aged patient accounts.

ESSENTIAL FUNCTIONS:

• Supports, and performs according to, approved policies and procedures.
• Posts payments and denials; processes mail backs from insurance.
• Calling patients regarding outstanding balances
• Responds to emergency situations with competence and composure.
• Objectively evaluates suggestions or criticisms and attempts to improve performance or seeks further guidance as needed.
• Assists patients or family by answering questions or resolving discrepancies in billing, charges & reimbursements.
• Assists patients or family in planning a payment schedule
• Seeks new learning experiences by accepting challenging opportunities and responsibilities.
• Attends and actively participates in meetings, committees, in-services, seminars, workshops, conferences, quality management activities according to job responsibilities and Practice requirements.
• Communicates effectively with co-workers, physicians, visitors, patients and other organizations
  • Interactions are respectful and courteous.
  • Objectively evaluates suggestions, grievances, and processes to identify opportunities to improve performance and quality of care or seeks further guidance, as needed.
  • Communicates effectively and professionally using a translator when necessary.
  • Documents that information received from the patient is disseminated to the appropriate people or departments.
• Supports the philosophy, goals, and objectives of the Practice.
  • Supports, and performs according to, approved policies and procedures.
  • Supports risk management and participates in programs directed to patient and staff safety.
  • Considers patient rights in performance of job duties and responsibilities.
  • Contributes to the quality management process; identifies role and contributions upon request.
• Reports observed or suspected violations, hazards, and noncompliance according to Practice policy.
• Contributes to the quality management process; identifies role and contributions upon request.
• Research and following up on claims denials and drafting appeals letters as necessary
• Assists patients or family in planning a payment schedule.
• Sends requested information (x-rays, etc.) with claim forms, pre-determinations & mail backs.
• Assists in obtaining and follows up on authorizations for office procedures.
• Interactions are respectful and courteous.
• Observes safety measures in performance of job duties and responsibilities.
• Counsels patients about Practice charges and insurance coverage.
  • Posts payments and denials; processes mail backs from insurance.
  • Sends requested information (x-rays, etc.) with claim forms, pre-determinations & mail backs.
  • Investigates and re-files problem claims.
  • Files secondary insurance after primary insurance has paid.
  • Assists patients or family by answering questions or resolving discrepancies in billing, charges & reimbursements.
  • Assists patients or family in planning a payment schedule.
  • Assists in obtaining and follows up on authorizations for office procedures.
  • Provides back-up support for front desk as needed.
  • other duties as necessary.
• Provides back-up support for front desk as needed.
• Maintains and promotes professional competence through continuing education and other learning experiences.
  • Seeks new learning experiences by accepting challenging opportunities and responsibilities.
  • Objectively evaluates suggestions or criticisms and attempts to improve performance or seeks further guidance as needed.
  • Attends and actively participates in meetings, committees, in-services, seminars, workshops, conferences, quality management activities according to job responsibilities and Practice requirements.
• Other duties as necessary.
• Reporting status of monthly accounts to Manager
• Files secondary insurance after primary insurance has paid.
• Taking payments over the phone
• Adheres to safety policies and procedures in performing job duties and responsibilities.
  • Reports observed or suspected violations, hazards, and noncompliance according to Practice policy.
  • Observes safety measures in performance of job duties and responsibilities.
  • Responds to emergency situations with competence and composure.
• Investigates and re-files problem claims.
• Communicates effectively and professionally using a translator when necessary.
• Supports risk management and participates in programs directed to patient and staff safety.
• Considers patient rights in performance of job duties and responsibilities.
• Objectively evaluates suggestions, grievances, and processes to identify opportunities to improve performance and quality of care or seeks further guidance, as needed.
• Tracking insurance/payment trends
• Reviewing assigned patient accounts monthly
• Documents that information received from the patient is disseminated to the appropriate people or departments.
• Assists in obtaining and following up on authorizations

KNOWLEDGE/SKILLS/ABILITIES:

Education/Certification/Experience:

• 2-3 years medical &/or dental office experience preferred
• Training/experience in business office activities preferred
• High School Diploma/GED