Job Description
Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.
Purpose:
Ensures prompt collection of the appropriate amount due
Essential Duties/Responsibilities:
- Follow-up with carrier regarding outstanding claims as noted on the outstanding invoice report
- File claims that require additional documentation
- Verify benefits as requested by physician
- Change insurance information as appropriate
- Correspond to carrier for such things as appeals and or inquiries
- Communicate all insurance regulation changes to supervisor
- Contact patient and or carrier to follow-up on denials and termination of coverage
- Respond to telephone calls; review and respond to correspondence
- Process computer refunds due patients and insurance companies
- Establish payment plans
Other Duties:
- As assigned by manager
QUALIFICATIONS
Required:
- High school diploma or general education degree (GED)
- 3-5 years' experience in a medical office environment or equivalent combination of education and experience
- 2-3 years of experience in medical billing, specifically with claims denials, appeals, corrected claims. May have a remote option at a certain point.
Preferred:
- Experience in Medical Office Administration
- Knowledge of the OSHA and DOT regulations
Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information, or any other class protected under state or federal law.
ADA Physical Demands:
Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)
Physical Demand | Required? | Frequency |
Standing | Occasionally | |
Sitting | Continuously | |
Walking | Occasionally | |
Kneeling/Crouching | Rarely | |
Lifting | Rarely |
Insurance Advisor Competencies
General
- Customer Service
- Professionalism/Integrity/Responsibility
- Teamwork/Process Focus
- Dependability/Punctuality
- Interpersonal Relationships/Communication
- Judgment/Decision Making/Problem Solving
- Quality/Quantity
- Initiative
- Safety/Housekeeping
- Organizational Skills/Time Management
Department Specific:
- Decision-making skills regarding ‘next step’ when working appeals
- Resourceful in finding appropriate information to assist in resolving the issue at hand
- Up-to-date with carrier changes as well as specialty-specific changes
- Effectively communicate changes to departments and co-workers
- Use all available tools and resources to accomplish job duties in an efficient and timely manner
- Strong computer skills, i.e., Windows environment, word processing, spreadsheets, etc.
- Effective use of software and web-based carrier sites for submission of claim and requested documentation
- Reliable source of information in regards to assigned carrier rules and requirements