SPECIAL ACCT INS TEAM LEAD - FULL TIME

Description

Essential Functions
Follows up on open claims in accordance with established guidelines. Reviews claims for completeness and compliance with the billing guidelines.

Works to resolve disputes of third-party denials. Contests charges that are not paid or underpaid with the carrier. Accesses available third party and governmental on-line services. Documents all actions within the system.

Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or Federal governmental, HCFA, or CPT billing and reimbursement guidelines. Reviews bulletins, updates, etc., and maintains as reference/ resource material.

Possesses a comprehensive understanding of how to enter insurance information into the billing system. Remain current on new FSC’s that are created and understand how they are used. Reviews and edits registration information according to clinic policy.

Cross train in all areas within the Insurance Department. Assist Supervisor in the education of new employees, the monitoring of staff and workflow in all areas of claims processing and payment posting within the Insurance Department.

Accesses available third-party and government on-line services. Accesses appropriate websites to obtain current carrier guidelines, verify eligibility and re-files claims if necessary.

Supervisory Responsibility
N/A

Work Environment & Physical Demands

Assist patients with disabilities and provide reassurance to those who may be anxious. Requires arm strength to hold the transducer steadily over patients. The role involves continuous learning, frequent bending, and physical activity.

Manual Dexterity Required: Ability to manipulate transducer and patient to get appropriate views. Wheelchair operation.

Travel
No travel is expected for this position other than occasional travel to corporate sites regarding employee relations issues.