Insurance Reimbursement Specialist II

Kootenai Health - Coeur d'Alene, ID

Full-time - Entry Level

Hybrid - Coeur d'Alene, ID

Hospitals

About the position

The Insurance Reimbursement Specialist II is responsible for the timely follow-up of insurance and government payer balances on hospital and professional accounts receivable. The role aims to ensure prompt payment, prevent payment delays, and resolve claims inquiries, rejections, and denials from third-party payers. This position plays a crucial role in reducing accounts receivable days, preventing bad debt, and maximizing net revenue and cash flow from patient billing operations.

Responsibilities

• Analyze A/R reports to perform collection follow-up on outstanding receivables, and determine the appropriate prioritization of follow-up action required.
• Work with payer websites, electronic tools, phone and other mechanisms, to ensure timely and full payment from third party payers.
• Review remittance advice for no pays or short pays to verify proper reimbursement, conduct follow-up with payers, or to make adjustments as necessary.
• Identify coding and billing errors from the EOB and work with all partner departments to correct errors and re-bill in a timely manner.
• Appeal improperly adjudicated claims so they are promptly corrected and paid.
• Support Revenue Cycle by providing A/R, denials and appeals information, in required reporting formats.
• Support Customer Service, Financial Counseling, and Patient Advocacy in response to patient billing inquiries or complaints.
• Provide support to registration, customer service, billing and accounts receivable collections functions, as appropriate.
• Interact with patients, clinicians, insurers, and billing management to ensure timely submission of appeals and timely collection of accounts.
• Perform duties in compliance with state and federal regulatory requirements, and Kootenai Health policies and procedures governing Revenue Cycle compliant processes.
• Perform other related duties as assigned.

Requirements

• High school diploma preferred; Billing Specialist Certification or Associates degree preferred.
• 5 years' professional experience working in a hospital or medical office with current commercial and government payer types, and strong understanding of payment methodologies.
• At least 2 years' hands-on experience processing 1500 or UB billing forms.
• Demonstrated ability to navigate through commercial payer and government agency websites, to research and understand billing requirements and instruction, and regulatory guidelines.
• Demonstrated ability working in hospital and professional EMR billing, and supporting eligibility systems, and ability to read and understand a patient medical record sufficient to conduct HB or PB claims-related research.
• Medical terminology understanding required.
• Excellent communication, organizational and analytical skills required.
• Ability to work equally well in a team environment, and independently with minimum supervision.
• Knowledge and demonstrated competence working with Microsoft Office software, to include Excel, Word, and e-mail programs to include reporting.

Benefits

• Dental insurance
• Health insurance
• Retirement plan
• Tuition reimbursement
• Vision insurance
• Wellness program