Reimbursement Specialist - Insurance Verification

HELP OTHERS, MAKE A DIFFERENCE, SAVE A LIFE.

At the McNabb Center, our mission is "Improving the lives of the people we serve."  Do you see yourself as a part of this life-changing work? If so, we are currently seeking a qualified and motivated professional for the following position: Reimbursement Specialist - Insurance Verification. 

SUMMARY

The purpose of the Reimbursement Specialist - Insurance Verification is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance.  Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate.  The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions. Will be required to work regular office hours at the designated facility.

REQUIREMENTS

Education:    High school diploma or equivalent required.

Experience:   Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties.

Applicants should possess the ability to relate to individuals of varied ethnic and cultural backgrounds, ages, educational levels, and economic circumstances with respect and dignity.  Excellent verbal, written, and computer skills are necessary in order to work effectively and collaboratively with others, collaborating agencies, and community professionals, as well as maintaining proper documentation. 

Physical: Hearing of normal and soft tones as well as close eye work. Frequent sitting, standing, walking, bending, stooping, and reaching.

COMPENSATION: Starting salary is approximately $15.39/hour and up depending on relevant experience and education.

NOTE: The job duties listed are typical duties of the work performed. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty.

  • Analyzes designated eligibility reports on a daily basis.
  • Communicates with and advises Insurance Verification Team Leader of all questions problems related to insurance verification.
  • Adheres to all policies and procedures related to compliance with all federal and state billing regulations.
  • Communicates with billing representatives regarding any insurance issues that may arise.
  • Maintains a positive and professional attitude.
  • Reads all emails and responds accordingly in a timely manner.
  • Listens to all voicemails and respond accordingly in a timely manner.
  • Works with members of various teams and/or departments on identifying process improvements.
  • Possess flexibility to work overtime as dictated by department/organization needs.
  • Assists in determining proper courses of action for resolution to insurance issues.
    • Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
    • Possesses strong ability to think outside the box.
    • Has the ability to work in a high stress/demanding environment.
    • Performs additional duties as requested by Team Leads or Management Team.

JOB QUALIFICATIONS

  • Advanced use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application).
  • Knowledge of Centricity is a strong plus.
  • Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid and Private Pay.
  • Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems.
  • Strong written and verbal communication skills.
  • Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
  • Knowledge of the center's Policies and Procedures.
  • Ability to maintain records and prepare reports and correspondence related to the position.
  • Ability to work directly with upper leadership regarding claims issues and resolutions.
  • Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others.

The McNabb Center (www.mcnabbcenter.org) is a premier not-for-profit provider of behavioral health services.  The Center provides quality care and serves all ages in a continuum of prevention, early intervention, social, co-occurring, addiction, outpatient, and crisis services.

MC is an EOE. MC conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing.  Bilingual applicants are encouraged to apply.

This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required.  This organization reserves the right to revise or change job duties as the need arises.  Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities.  This job description does not constitute a written or implied contract of employment.