Insurance Specialist

Insurance Specialist

Business Services Department

0.60 FTE, 48 Hours a Pay Period

Days, Hours between 7:30 am - 4:00 pm

Weekends: No

Holidays: No

Telecommute Available: Partial

Position Overview:

The Insurance Specialist is responsible for the back-end office processing of insurance claims for Winona Health Services. Responsible for processing claims including but not limited to answering inquiries from insurance companies and patients, rejections, denials, appeals and incorrect payments, follow-up of past due claims, monitor payment/adjustments from contracted insurance payments, and identifying credit/refunds on accounts to keep A/R days within goal range of 35 - 45 days. Responsible for back-end office processing of insurance claims in a designated section of the alphabet and/or payer split as determined by the Director/Supervisor. May also work with nursing home client billing for Medicare Part A billing requirements. Position is responsible for the back-end office processing of claims which may include one or more of the following; checking eligibility and resubmitting insurance claims through clearinghouse according to insurance, state and/or federal regulations.

Essential Duties & Responsibilities:

• Researches and monitors all accounts in assigned work queues, reprocesses claims, working with Health Information Management (HIM) or specific department on billing/coding issues and initiates adjustments in billing software systems as needed for Medicaid, Blue Cross, Workers Compensation, Medicare, Medicare Advantage and Commercial insurance claims.

• Researches credit balances found through work queues and patient/first party collection calls. Follows through with and/or works with cash receipts staff to expedite refunds to insurance companies and/or patients.

• Answers calls from patients or staff with billing questions. Works with other business office staff (Patient Account Specialist, Cash Receipts Specialist, 1st party collection staff, Prior Authorization, Financial Counselors, Transactions Services and Senior Services Patient Account Coordinator) for patient account questions/issues.

• Logs patient complaints in software system as needed.

• Other miscellaneous duties as needed to maintain efficient operations of revenue cycle department which can include; covering charge services, Patient Account Coordinator, Specialty Services, and/or Senior services, sorting mail.

• Designated as a superuser to test software system updates/upgrades and performs other miscellaneous office functions as requested by the Manager and/or Director.

Supervisory Responsibilities:

No direct reports

Skills and Experience:

Required:

• Associates Degree in related field of study or equivalent training or experience in claims filing/appeals or business related field

• Attention to detail and ability to multi-task is essential

• Intermediate computer skills: Word, Outlook, & Excel

• Must possess effective customer service oriented communication skills

Internal Applicant Policy:

It is the policy of Winona Health to work with employees in an equitable fashion regarding promotions, transfers, and position reclassifications.

Any employee wishing to apply for another available position at Winona Health must submit an application for consideration through the internal application portal. Employees requesting to change positions should have successfully completed at least six (6) months in their current position. Employees currently in the formal disciplinary process may be required to meet with the Director of Human Resources to determine eligibility to request transfer. The employee's past performance, experience, training and qualifications will be considered in transfer/hiring decisions. Consideration for transfer or promotion is not a guarantee of transfer or promotion. Employees may be given a chance to interview for a position when they meet the minimum position qualifications.

Disclaimer:

Winona Health is an equal opportunity employer. Winona Health does not refuse to hire, discharge, or discriminate against a person with respect to tenure, compensation, terms, upgrading, conditions, facilities, or privileges of employment because of race, color, creed, religion, sex, age, national origin, marital status, genetic information, status with regard to public assistance, membership in a local discrimination commission, sexual orientation, disability, veteran status, or any other prohibited basis of discrimination under applicable local, state, or federal law. Winona Health does not tolerate retaliation against any employee, patient/resident, physician, or other individuals pursuing concerns regarding Civil Rights issues. Winona Health adheres to ALL pertinent governmental policies and legislation including the Civil Rights Act of 1964, Title VII, as amended, and the Minnesota Human Rights Act.