Patient Benefits Specialist I

Job Details

Level: Entry

Job Location: IDX Coppell TX Site - Coppell, TX

Education Level: High School

Salary Range: Undisclosed

Description

Our Specialist will interact with patients, insurance carriers, medical facilities, and providers on a daily

basis to ensure a seamless front-end benefits verification, coordination and authorization process for all

tests. Our Specialist is responsible for providing excellent service by responding to questions from

patients, clerical staff, and insurance companies, as well as identifying and resolving patient billing

complaints.

Qualified candidates must be able to review accounts for billing accuracy in order to maximize

reimbursement. The ideal candidate will have strong attention to detail with the aptitude to learn our

medical billing and collections process specifically eligibility verification and prior authorization processes.

Our Specialist is responsible to work, research, and resolve front end errors. The mission of the Specialist

is to provide excellent customer service and performs a wide variety of complex patient benefits

investigation, coordination, and billing duties.

Key Job Elements

• Communicates with various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) to validate health plan eligibility, benefits, deductibles and maintains accurate documentation.

• Serves as the point of contact for patients to ensure accurate communication of health plan benefits and eligibility, and answers all patient concerns regarding coverage and billing details.

• Coordinates all patient and insurance billing for the medical laboratory; ensures that patient information is entered accurately, verify patient insurance eligibility and benefits, submit prior authorizations and submit clean claims to insurance companies on a daily basis.

• Reviews physician referrals for completeness and accuracy ensuring the referral includes patient information, diagnosis code, type of service, physician signature, date and authorization number is required.

• Faxes referral to referring physician if information is incomplete.

• Establishes payment plans to help patients manage their payments, provide customer service to patients.

• Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing.

• Confirms patient demographic, insurance and referring physician information is accurately entered into system.

• Identifies and bills secondary or tertiary insurances.

• Provides case progress, insurance inquiry and reimbursement report to management.

• Maintains contact with patients and medical facilities and provides updates on authorization progress and case processing status.

• Maintains patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

• Performs other related duties or special projects as assigned.

Qualifications

KNOWLEDGE / EXPERIENCE:

• High School Diploma

• Medical Certification is highly desirable.

• 1-3 years of Customer Service experience in the health industry.

• 1-3 years of work experience in Medical Billing and Coding.

• 1-3 years of work experience in high call volume setting with insurance and patients.

• Knowledge of and experience with CPT-4 and ICD-9 and HCPC billing, coding and posting charges in medical billing software.

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.

• Knowledge of insurance plan benefits and terminology.

• Knowledge of and experience with contract payer policies and procedures.

• Knowledge of HIPPA compliance.

• Proficient in Microsoft Office Suite applications

SKILLS & ABILITIES:

• Handles multiple tasks simultaneously.

• Communicates effectively with all levels of staff.

• Maintains composure while working under high pressure.

• Demonstrates strong interpersonal skills that foster a positive environment.

• Demonstrates flexibility and ability to adapt to change.

• Excellent communication, time management, and computer skills.

• Must be accurate with attention to detail.

• Customer service skills for interacting with medical billing clients and patients regarding medical claims and payments.

• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.

SUPERVISORY RESPONSIBILITIES:

• None

REPORTS TO:

• Director of RCM