Administrative

Position: Patient Accounts Insurance Specialist

Responsibilities:

• Conducts follow-up on all outstanding accounts as per established standards and procedures.

• Identifies reasons for denials and resolves them following departmental protocols and industry norms.

• Validates the accuracy of patient insurance and demographic data, making necessary updates to patient records.

• Serves as a liaison between healthcare providers, patients, and insurance companies, handling both hospital and professional claims.

Skills and Qualifications:

• Proficiency in medical terminology, coding, standard hospital operations, and financial services is advantageous.

• Familiarity with various health plans, including Commercial, Medicare, Medicaid, VA, and others.

• Knowledge of remittance advices, CARC (Claim Adjustment Reason Code), and RARC (Remittance Advice Remark Code) codes.

• Understanding of billing requirements for healthcare facilities and professionals.

• Competence in using personal computers, office equipment, and relevant software applications.

• Effective communication skills, both written and verbal.

• Successful interaction with staff and management at all levels; ability to respond positively to guidance and supervision.

• Capacity to work efficiently in a fast-paced environment, with strong multitasking abilities.

• Demonstrated ability to maintain confidentiality and act independently with minimal supervision.

• Initiative and sound judgment in carrying out responsibilities.

• Strong organizational skills, enabling effective work without direct supervision, efficient time management, and prioritization of multiple tasks to meet project deadlines.

• Proficiency in analyzing and solving complex system problems, as well as prioritizing, managing, and implementing complex projects.

• Effective collaboration and communication with various internal and external individuals, including multidisciplinary teams.

• Ensuring that recommendations align with federal, state, and other regulatory requirements.

• Flexibility in job schedule to provide user support and advance project goals.

• Consistent and punctual attendance at the assigned job location.

• Ability to create suitable teaching tools to cater to the diverse learning needs of prospective users.

Education/Certifications/Licenses/Degrees:

• High school graduate or equivalent

• Associates or Bachelors degree preferred

• Preferred certifications in healthcare, customer service, change management, project management, or process improvement

Experience:

• Experience with Epic, Soarian, EDM, MS4, ADT, claims, MIRA, DSG, Experian, Craneware, or other revenue cycle solutions software is required.

• Minimum of one year of work experience in healthcare revenue cycle preferred.

• Hospital and physician billing experience is preferred.

• Familiarity with PowerPoint, Word, and Excel is preferred.

• Preferred experience with 837i or 837p and HIPAA transaction sets such as CPT/HCPCS, revenue codes, ICD9 or ICD10, CARC, or CAS codes.

About the Facility: This healthcare institution in Coos Bay, Oregon offers a wide range of comprehensive medical services for individuals of all ages. Their services encompass pediatrics, childbirth and obstetrics, gynecology, oncology for cancer diagnosis and treatment, diabetes and kidney disease treatment, geriatric medicine, services for the elderly and disabled, emergency medicine, and various specialty medical services.