Insurance Specialist – CPAR Required

This is a fully remote position, open to applicants in Georgia.

📋 Description

• Act as the primary contact for patient inquiries regarding insurance claims, denials, coding, re-determinations, attorney settlements, and retro authorizations.

• Address credit balances and payment discrepancies by examining previous billing records and making necessary corrections.

• Serve as a subject matter expert on payer guidelines, underpayment recovery, aged denial resolution, and claim adjudication processes.

• Confirm and update patient insurance coverage and resubmit claims as needed.

• Review and modify patient accounts and insurance information.

• Achieve or surpass quality and productivity benchmarks set by SPRC leadership.

• Adhere to scripting and departmental protocols to guarantee high-quality service.

• Investigate and resolve patient inquiries via phone and electronic communication, managing complaints and escalating issues when necessary.

• Participate in weekly, monthly, quarterly, annual, and departmental meetings.

• Collaborate with patients and guarantors to locate or add insurance, third-party sponsorships, and settlements.

• Maintain a solid understanding of health insurance, EOBs, collection processes and techniques, as well as NGHS Financial Assistance Programs.

• Perform various assigned tasks, including managing work queues, processing itemized statement requests, Detail Bills, 1500s, and UBs.

• Positively contribute to departmental teamwork, idea generation, problem-solving, and recognizing billing and customer satisfaction trends.

• Communicate with patients and payers to resolve billing concerns, obtain necessary documentation, and review EOBs for payment accuracy.

• Contact insurance providers via telephone and online platforms to reprocess aged facility and professional claims.

• Identify and rectify posting errors, underpayments, and denials within the appeal timeframe; resubmit claims for late charges and other issues.

⛳️ Requirements

• Certified Patient Account Representative (CPAR) is required.

• Certified Professional Biller (CPB) or Certified Professional Coder (CPC); CPB or CPC must be obtained within one year of hire.

• High School Diploma or GED is necessary.

• A minimum of 3 years of experience in medical billing and/or medical coding is required.

• Knowledge of Revenue Cycle functions, which include registration, coding/charge posting, payment posting, and financial assistance.

• Comprehensive understanding of patient collections, billing regulations, denial follow-up procedures, and EOB interpretation.

• Proficient in personal computer use and capable of efficiently navigating between systems.

• Strong listening, problem-solving, and customer service abilities.

• Exceptional verbal and written communication skills along with telephone proficiency.

• Ability to work independently within established guidelines.

• In-depth knowledge of HIPAA regulations.

• Capable of reading, writing, reasoning, speaking, and using a keyboard.

• Ability to occasionally lift and carry up to 20 lbs.

🏝️ Benefits

• Commitment to being an Equal Opportunity Employer and upholding nondiscrimination principles.

• Opportunities to achieve personal and professional aspirations.

• Flexible remote work arrangements.