Third Party Insurance Claim Sp

Augusta University
Augusta University
Closing date
Sep 14, 2021

Job Details

Job Title: Third Party Insurance Claim Sp
Location: Augusta University
Regular/Temporary: Regular
Full/Part Time: Full-Time
Job ID: 230208

Required Qualifications Associate's or Bachelor's degree from an accredited college or university in a related field
High School Diploma, GED or equivalent from a recognized State or Federal accrediting organization plus four years' of progressively responsible office support experience with medical and/or dental insurance.Knowledge, Skills, & Abilities
    Ability to work independently and as a team-playerStrong organizational, prioritization and problem-solving skillsExcellent interpersonal, verbal and written communication skillsProficient with Microsoft Office and other computer software/databasesAbility to work efficiently in a fast-paced environment and maintain confidentialityAbility to make sound decisions and maintain professional and courteous mannerAbility to produce acceptable work volume and effectively meet established deadlines
Preferred Qualifications Associate's or Bachelor's degree from an accredited college or university in a related field
Background of dental office procedures and terminology; Ability to speak Spanish is a plus; Preferred medical & dental insurance experience.Responsibilities The Third Party Insurance Claim Specialist is responsible for managing and assembling factual data and documents required for timely third party claims submission. Coordinate the third party claim filing, reconciliation and problem solution to patient accounts. This includes claims to PPO, Medicare, GA & SC Medicaid, worker's compensation, VA, GA Correctional Healthcare and other third party payers and guarantors. Educate and assist patients, providers, and staff on all up-to-date policies, procedures and coding requirements. Manage aging report to problem solve denied claims for rebilling and/or appeal procedures. The duties include, but are not limited to:Forms:Initiate, coordinate, complete and/or process forms involving preauthorization coding, billing and reimbursement for all third party payers.Phones:Answer multiple phone lines - handle a variety of problems and issues with patients disputing bills, inquiring about status insurance claims, incorrectly filed claims, incorrect charges and/or changes in insurance coverage.Reimbursements:Record and post reimbursements; Balance and reconcile patient accounts including applying contractual write-offs when applicable.Patient Issues:Research and resolve patient problems and complaints of patient accounts by reviewing payments, treatment entries and notes entered within the Electronic Health Record.Claims Report:Generate, audit and resolve the pending claims report; Investigate and resolve returned, disputed or rejected insurance claims so re-submissions can be completed on a timely basis.Patients:Verify patient benefits, claim status and insurance coverage; Educate and assist patients, providers and co-workers regarding information required by insurance companies; Secure prior authorizations when necessary, helping advocate for maximum reimbursement coverage for patients.Credits:Identify and resolve credits on patient accounts by preparing and processing daily insurance and patient refund requests.Records:Maintain accurate insurance records, including documenting all actions taken on each account and follow up as needed.Other Duties:Perform other related administrative duties/tasks incidental to the functions department and the College as assigned.Shift/Salary Shift: Days/M-FPay Grade: 10Salary: $13.20/hr Salary to be commensurate with qualifications of selected candidate within the established range (generally minimum-midpoint) of the position Recruitment Period: 7/13/2021 - Until FilledConditions of Employment All candidates are required to successfully pass a Background Check review prior to starting with Augusta University. Compliance with AU Confidentiality Policies:
  • All employees are responsible for ensuring the confidentiality, availability, and integrity of sensitive [patient, student, employee, financial, business, etc.] information by exercising sound judgment and adhering to cybersecurity and privacy policies during the course of their employment and beyond.
Equal Employment Opportunity Augusta University is proud to be an equal opportunity employer welcoming applicants from underrepresented groups, including individuals with disabilities and veterans.Other Information This position is also responsible for promoting a customer friendly environment and providing superior service to our patients, students, faculty, and employees. “Augusta University is a patient-and family-centered care institution, where employees partner everyday with patients and families for success.”Augusta University is a tobacco free environment and the use of any tobacco products on any part of the campus, both inside and outside, is strictly prohibited.

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