JOB TITLE: INSURANCE BILLING SPECIALIST

REPORTS TO: Business Office Manager

I. JOB SUMMARY / OVERVIEW

 Interrelates with providers, insurance companies, other health care organizations, the

public, and staff in relation to insurance, credentialing, invoicing, accounts payable

accounts receivable, journal entries, and reconciliation.

II. PRIMARY DUTIES

Every effort has been made to include all duties; however, the omission of a specific

statement of duties does not exclude the duty from the position if the work is similar,

related or is a logical assignment of the position.

 Respond knowledgeably and courteously to inquiries from patients, providers, staff and

insurance companies.

 Process insurance claims on a daily basis. Work promptly and efficiently so claims are

paid timely.

 Post payments from insurance companies to proper patient accounts.

 Process refunds for insurance companies and patients as necessary.

 Follow up on, track, and investigate claim denials or claims not paid correctly for

current and aged receivables.

 Keep abreast of all changes and billable charges within individual insurance companies.

 Creates, tracks, and collects all invoices for medical records, OSHA, OCM, ect.

 Performs miscellaneous job-related duties as assigned.

III. EDUCATION / QUALIFICATIONS

 High school diploma or GED.

 Experience with medical insurance billing required

 Familiarity with ICD and CPT coding helpful.

 Knowledge of computer accounting programs, spreadsheets and applications.

 Knowledge of accounts receivable, basic accounting, and management principles.

IV. EXPERIENCE / KNOWLEDGE / SKILLS

 Knowledge of medical terminology, coding, and office procedures.

 Knowledge of third party and insurance procedures, regulations, and billing

requirements.

 Ability to identify, solve problems and correct errors.

 Ability to interpret billing and claims reports.

 Ability to function independently in prioritizing and organizing daily work.

 Demonstrate attention to detail.

 Ability to speak, read, write and comprehend instructions in English.

V. PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an

employee to successfully perform the essential functions of this job. Reasonable

Insurance Billing Specialist 1accommodations may be made to enable individuals with disabilities to perform the

essential functions.

 While performing the duties of this job, the employee is regularly required to sit, use

hand and fingers, handle and feel objects, reach with hands and arms, talk and hear.

VI. MISCELLANEOUS

 Accepts and is supportive of change.

 Accepts guidance and suggestions for improvement.

 Willing to assist and work with others.

 Maintain strict and total personnel and patient confidentiality.

 Attend all required in-service meetings and department meetings.

 Complies with PrairieStar Health Center Policy & Procedure.

 Attend all required in-service sessions.

 Attend all required clinic meetings.