Insurance Reviewer II

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment from third-party payors and reporting to management on observed trends and issues.

Job Relationships

Reports to the Insurance Review Supervisor

Principal Responsibilities

• Handle all phone calls and messages received specific to designated insurance area.
• Update registration screens when requested by patients or as necessary.
• Review and process all designated insurance vouchers received, rebilling charges not paid and processing adjustments as needed utilizing websites or telephone as necessary.
• Process all secondary billing as requested by patients or defined by procedure.
• Distribute incoming insurance mail received and respond to all audits, inquiries and additional information requests.
• Process corrections/adjustments as necessary to correct the patient's invoice.
• Process designated insurance reviews when requested to obtain additional payments on claims utilizing websites or telephone as necessary.
• Analyze and process front-end system edits for correct physician productivity and billing of claims.
• Analyze and process back-end system edits for correct registration and billing of claims.
• Analyze and process claims denied through clearinghouse.
• Investigate and process claims in the insurance work files and/or on the insurance reports.
• Must report all incidents to immediate Supervisor or Manager.
• Assist with special projects and assignments as directed.
• Must attend in-services and training relevant to position.
• Perform other job duties as assigned.
• Confidentiality required.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to SC Way customer service philosophy.

Education/Experience

• High School graduate or GED required.
• Previous experience in a medical billing office required.

Knowledge, Skills and Abilities

• Working knowledge of medical terminology preferred.
• Working knowledge of CPT and ICD-9 coding preferred.
• Computer, typing and calculator skills required.
• Must be able to work individually or on a team.

Working Environment

Office environment, sitting for long periods

PHI/Privacy Level

HIPAA1