Adeptus Health is a leading patient-centered healthcare organization expanding access to the highest quality emergency medical care through its network of freestanding emergency rooms and partnerships with premier healthcare providers. All Adeptus Health freestanding facilities are fully equipped emergency rooms with a complete radiology suite of diagnostic technology, on-site laboratory, and staffed with board-certified physicians and emergency trained registered nurses. For the last four years, Adeptus Health has exceeded the 95th percentile in patient satisfaction according to patient feedback collected nationwide by Press Ganey Associates Inc. Adeptus Health also was named a 2016 and 2017 Best Workplaces in Healthcare by Great Place to Work® and Fortune Magazine. For more information, please visit adpt.com.
The Insurance Collections Specialist is responsible for the accuracy and timeliness of handling claims on denial reports. The purpose of the position is to the generate revenue, ensure insurance benefits are accurate and to maintain the integrity of the patient account. This is a non-exempt position.
Job Responsibilities and Duties
Essential Job Functions:
• Obtains policy and benefit information such as policy type, covered services, deductible, co- insurance and Explanation of Benefits.
• Responsible for performing billing, collections and reimbursement services of claims for Emergency Department patients.
• Ensure all claims billed and collected meet insurance carrier standards in a prompt and efficient manner
• Accurately documents patient accounts, resolve incoming mail and correspondences
• Communicate Payer trends to management
• Maintains strict confidentiality in accordance with HIPAA regulations and company policy
• First and second level appeals, as needed
• Requires a thorough knowledge of the necessary practices and procedures for Professional Billing, Facility Billing, Insurance Verifications, Third Party Insurance coverage, Medicaid and Medicare follow up, Insurance denial review and overturn procedures
• Must be thorough, efficient, understanding and maintain a pleasant manner with patients and staff
• Possess excellent knowledge of all PHI Protected health information guidelines of sensitive medical information
• Attendance requirements are based on your current role and status of position (FT, PT or PRN). Please direct attendance requirements to your immediate supervisor and/or refer to the Employee Handbook for more attendance/scheduling details/policies
There are no supervisor responsibilities required
Please note this job description is not designed to cover in detail, or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
• High attention to detail
• Ability to work in stressful, fast-paced environment
• Excellent organizational skills and prioritize tasks effectively
• Able to work independently and follow established guidelines
• Time Management
• Communication Proficiency
• Technical Capacity
• Customer/ Client focus
Education and Experience:
• High school diploma or GED equivalent required
• Two years of billing and health care experience
• Ability to read, analyze and interpret insurance carrier Explanation of Benefits
• Demonstrate excellent customer service skills when communicating with co-workers, physicians, peers and clients
• Understanding of CPT, ICD-10 and HCPCS
• Familiarity with DDE
• Must be able to handle confidential situations and account information in accordance with HIPAA guidelines
• Willing to work overtime as needed
• Willingness and ability to learn new tasks
• Knowledge of Microsoft Office