Job Description
JOB TITLE: MEDICAL INSURANCE SPECIALIST
EMPLOYER: KIM TANG MD INC
DEPARTMENT: INSURANCE
REPORTS TO: INSURANCE BILLING DEPARTMENT MANAGER
EFFECTIVE DATE: 03/01/2024
SUMMARY: Under direct supervision of the billing department manager this position’s daily responsibilities include but are not limited to medical claim submissions, posting insurance EOBs, processing patient payments, working accounts receivable and obtaining medical authorizations. This position requires effective communication with physicians, patients, insurance carriers, and pharmacies.
DUTIES AND RESPONSIBILITIES:
Identify benefit coverage of HMO, PPO, primary, secondary or tertiary insurance coverage
Accurately enter insurance billing information
Submit requests for HMO authorizations
Submit medical claims to insurance companies
Post insurance and patient payments
Work accounts receivable aging – both insurance and patient accounts
Contact patients regarding past due account balances
Submit patient accounts to collections
SUPERVISORY RESPONSIBILITIES:
QUALIFICATIONS:
Minimum 1-year medical insurance department experience required.
Basic knowledge of CPT and ICD 10 billing codes with regards to claim submission
Ability to interpret insurance explanation of benefits
Knowledge of HMO insurance requirements – Ability to review physician orders for medical necessity and accuracy to support authorization requests.
Professionally communicate with patients regarding insurance questions and account balances.
COMPETENCIES:
Diversity - Shows respect and sensitivity for cultural differences
Ethics - Treats people with respect; Works with integrity and ethically; Upholds organizational values.
Attendance/Punctuality