Our organization is seeking a full-time Business Services, Insurance Specialist who will be responsible for all aspects of healthcare claim denials and accounts receivable. The ideal candidate will ensure all claims are submitted timely, accurately, and in accordance with payor and organization policies and procedures. The ideal candidate will have prior experience in a billing office working with claims submissions to insurance companies. The Insurance Specialist will assist with payor audits, identification of claim processing trends, and be responsible to review and understand billing policies and procedures. The ability to work well independently and within a team in a collaborative environment is essential.
Monday - Friday, day shift. Wage will depend on experience.

You are eligible for our excellent benefits package on the 1st of the month following 30 days of employment. Those benefits include:

  • Health (2 plan options)
  • HSA & Flex Account
  • Dental
  • Aflac
  • STD, LTD, Life Insurance & AD&D
  • 401k with employer contribution 
  • Multiple exciting other employee perks, to include discounts at places local to Rapid City. (enjoy these perks right away)
GENERAL SUMMARY OF DUTIES:  Responsible for understanding and staying current with payor policies and guidelines. Process claim denials in to ensure proper and compliant reimbursement post payor processing of claims.

ESSENTIAL FUNCTIONS:
  • Responsible for insurance accounts receivable
  • Follow up on unpaid claims utilizing the established workflows
  • Responsible to ensure claims are worked in the proper manner; ensure all corrected claims and appeals are completed correctly and in a timely manner
  • Assist in payor audits by collecting, reviewing, and collaborating with multiple departments to submit information and responses in a timely manner
  • Responsible to review updates and policy changes communicated by payors via newsletter or other correspondence
  • Communicate identified trends to varying levels of leadership
  • Collaborate with multiple departments to resolve identified trends and workflow improvements
  • Maintains patient confidentiality
  • Performs other duties as assigned

EDUCATION: High school graduation or GED.

EXPERIENCE:  Minimum of one year of experience in a billing office working with claims submissions to insurance companies.  Preferred experience in working with insurance companies regarding insurance claims and denials.

KNOWLEDGE, SKILLS, AND ABILITIES
  • Knowledge of medical terminology, medical billing, insurance claims processing, and collection practices
  • Ability to read and interpret an Explanation of Benefits
  • Knowledge of clinic operations
  • Knowledge of a practice management and EMR system, eClinicalWorks preferred
  • Ability to multi-task and work under pressure in a deadline driven environment with changing priorities
  • Ability to communicate clearly in person, in writing, and on the phone to establish/maintain cooperative relationship with patients, families, physicians, staff and other customers
  • Strong organizational and problem-solving skills
  • Strong customer service skills
  • Basic knowledge of Microsoft Word and Excel
  • Skill in using web-based healthcare coding programs and systems
  • Ability to examine insurance documents to ensure accuracy and completeness
  • Ability to prepare insurance records in accordance with detailed instructions

PHYSICIAL AND ENVIRONMENTAL WORKING CONDITIONS
  • Job requires largely sedentary role requiring one’s ability to sit for extended period of time.
  • Ability to occasionally lift and/or move up to 10 pounds.
  • Must be able to talk, listen and speak clearly on telephone

 

Department: Business/Billing Office
This is a full time position

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