计费专员 II (NAVA)
Billing Specialist II (NAVA)
薪资范围：
职位描述：
保险专家是一个全职、常规岗位，工作时间为周一至周五远程办公
简介：负责处理大量未支付或错误支付的索赔，以确保准确和及时的报销。理赔专家II负责进行高级索赔跟进、拒绝解决和保险公司问题管理，要求高度的准确性和独立性。
总体描述：理赔专家II执行与第三方索赔相关的复杂医疗理赔功能。这包括审查未支付的索赔和拒付，必要时重新提交索赔，分析保险公司趋势，解决信用余额，研究患者索赔问题，并协调解决系统性保险公司问题。此职位要求至少一年的医疗环境中的保险、理赔或索赔经验。
主要职责：要成功履行此工作，个人必须能够满意地完成每项职责。为使有残疾的个人能够履行基本职能，可能做出合理的调整。
- 通过致电查询付款状态、提交申诉并根据需要更正/重新提交索赔来审查未支付的索赔。
- 跟保险公司跟进任何未支付或错误支付的服务。
- 当收集专家不在时，协助患者解答保险相关问题。
- 根据经验，对最高达500美元的不可收回余额进行核销。
- 在向保险公司提交索赔前解决索赔编辑（缺少索赔信息）问题。
- 与供应商合作解决保险公司问题。
- 更正录入差异，使其与保险公司审核结果一致。
- 研究已收到但尚未录入的付款。
- 与认证联络人协调解决供应商注册问题。
- 参加每月会议，了解政策更新和变化，并将相关信息传达给领导层。
- 与转诊医生办公室合作获取追溯授权或转诊号码。
- 联系客户关于逾期账户，提供所需信息，并向领导层沟通费用差异。
- 参与同行培训和质量保证活动。
- 在需要时支持LLC员工处理现场资格查询。
- 执行特殊项目和其他指定任务。
- 内部晋升路径至二级
- 现任Navani员工
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Base Pay Range:
Job Description:
The Insurance Specialist is a Full Time, Regular position working remote Monday-Friday
Summary: Responsible for addressing large volumes of unpaid or incorrectly paid claims to secure accurate and timely reimbursement. The Billing Specialist II performs advanced claim follow-up, denial resolution and payer issue management with a high degree of accuracy and independence.
General Description: The Billing Specialist II performs complex medical billing functions related to third-party claims. This includes reviewing unpaid claims and denials, rebilling as needed, analyzing payer trends, resolving credit balances, researching patient claim concerns and coordinating solutions for systemic payer issues. This role requires a minimum of one (1) year of insurance, billing or claims experience in a healthcare setting.
Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Reviews unpaid claims by calling for payment status, submitting appeals, and correcting / resubmitting claims when necessary.
- Follows up with insurance companies for any unpaid or incorrectly paid services.
- Assists patients with insurance questions when Collections Specialist is not available.
- Writes off uncollectible balances with dollar values as high as $500 (dependent on experience).
- Resolves claim edits (missing claim information) prior to the submission of the claim to insurance companies.
- Works with vendors to resolve payer issues.
- Corrects posting discrepancies to align with payer adjudication.
- Researches payments received but not yet posted.
- Coordinates with credentialing liaison to address provider enrollment issues.
- Attends monthly meetings to stay updated on policies, upcoming changes and communicates relevant information to leadership.
- Works with referring physician offices to obtain retroactive authorizations or referral numbers.
- Contacts clients regarding overdue accounts, provides requested information and communicates charge discrepancies to leadership.
- Participates in peer-to-peer training and quality assurance activities.
- Supports the LLC staff with onsite eligibility inquiries as needed.
- Performs special projects and additional duties as assigned.
Internal Promotion Pathway to Level II
Current Navani employees may be promoted from Billing Specialist I to Billing Specialist II upon meeting all of the following:
- Completion of one (1) full year of continuous service at Navani as an Billing Specialist I
- Consistently meeting or exceeding performance metrics and quality benchmarks for at least six (6) consecutive months.
- Demonstrated ability to manage complex claims, denials, payer follow-up, and problem solving with minimal supervision
- Demonstrated good attendance, meeting departmental standards and maintaining reliability in schedule adherence.
- Recommendation of leadership
(Promotion is not automatic; final approval is at management discretion)
General Duties/Responsibilities:
- Ability to maintain strict confidentiality within the Inland Imaging companies and Inland’s customers.
- Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.
- Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.
- Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.
- Honest, pleasant manner and good personal hygiene.
- Free of alcohol and drug abuse.
- Ability to access multiple worksites in a timely manner.
- Excellent communication and interpersonal skills.
- Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
- Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
- Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.
- Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
- Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
- Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.
- Quarterly quality assurance meeting attendance is required for this position.
- Attendance is a requirement for this position.
- Requires flexibility with scheduled work hours the final week of the month/year to ensure all available dollars are posted to client A/R system by close of business.
Supervisory Responsibilities:
· There is little or no supervisory responsibility in this position.
Advocacy:
Treats all clients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values:
· Show We Care, Do The Right Thing, Maximize Individual Potential, Challenge Convention
Qualifications:
- Education: High School Diploma/GED required· Two years of medical billing course preferred
- Experience:
- Minimum of one (1) year in medical experience in medical billing, insurance follow-up, claims processing or related patient accounts work required.
- Working knowledge of Imagine Software or other patient accounting systems preferred
- CPT and ICD-10 coding experience preferred
- Strong customer services skills required
- Licensure: N/A
- Certifications: N/A
- Computer Skills: Experience with the following computer applications is highly desired: Microsoft Office Suite (Outlook, Word, Excel), Workday, Webex, Internet/Intranet, Meditech, Code Correct, Medinformatix, Imagine, PhiCure, Waystar.
- Background Check:
- Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
- In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG). Employees must not be included on this list.
- Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test.
Nuvodia/Inland is an EEO employer...
Originally posted on Himalayas