Insurance Specialist III - Work From Home

***Xtend offers competitive benefits including; Medical/Dental/Vision, Generous Paid Time Off/Paid Holidays/Monthly Bonus Eligibility/Tuition Reimbursement/401k plan plus Employer Match/Professional Development***

Xtend Healthcare, a Navient company, is nationally recognized as the industry-leading provider of comprehensive revenue cycle solutions to hospitals and health systems. Sustaining healthcare revenue cycle improvement is our exclusive focus with experience in all 50 states and more than 30 years of dedicated health revenue cycle experience. We are committed to delivering solutions built around the broad revenue cycle needs of our clients.

Xtend Healthcare focuses on both clinical and financial interoperability to maximize collection of net revenue. Xtend Healthcare provides an array of solutions for our customers including full and partial revenue cycle outsourcing, third-party insurance follow-up, self-pay, coding, CDI, and consulting services.

THIS WILL BE A REMOTE (WORK FROM HOME) POSITION.

Xtend Healthcare is looking for Insurance Specialist III is responsible for review and resolution of outstanding insurance balances on hospital or physician patient accounts. The Insurance Specialist will be required to have flexibility to learning and comprehending complex hospital systems and keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client and federal guidelines.

JOB SUMMARY:

1. Effectively manages assigned insurance receivables to achieve business line expectations.

• Exceed productivity standards as outlined by business line Exceeds a minimum of 85% work quality scoring and accuracy on all accounts worked.
• Completes timely follow-up on assigned accounts to ensure no cash loss.
• Exceeds monthly cash expectations as set out for assigned client receivables Ensures insurance accounts are resolved within 90 days of placement.
• Demonstrates the ability to prioritize work with minimal oversight to meet outlined goals.
• Acts as a knowledge resource for team members.

2. Perform account research and route accounts through appropriate client workflows.

• High level understanding of client host system functions Clearly documents actions taken and next steps for account resolution in patient accounting system.
• Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system.
• Demonstrates advanced understanding of commercial and Medicaid payers.
• Has knowledge of Medicare guidelines and is able to accurately perform corrections according to CMS guidelines.
• Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions)
• Compiles appeals and approves appeal requests for team related to technical payment denials Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
• Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms Ensure strong communication skills to convey intricate account information.

3. Ensure all accounts are worked within client standards and Federal Regulations.

• Maintain high quality account handling per client standards.
• Work within federal, state regulations, department/division & all Compliance Policies.
• Maintain clear, concise, and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications.

4. Maintain continuing education, training in industry career development.

• Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
• Attend training sessions as directed by management Integrate information obtained through training sessions and policy changes immediately into daily routine.

MINIMUM REQUIREMENTS:

• High School Diploma (additional equivalent experience above the required minimum may substitute for the required level of education)
• 3 to 5 years’ accounts receivable and billing experience in a hospital environment (additional equivalent education above the required minimum may substitute for the required level of experience)
• Excellent oral and written communication skills
• Basic computer skills
• Familiar with widely used patient accounting software

PREFERRED QUALIFICATIONS:

• Organization, planning and prioritizing
• Communication skills
• Data management
• Attention to detail and accuracy
• Problem-solving
• Adaptability and flexibility
• Possess excellent reading and writing skills
• Strong Computer skills
• Ability to communicate successfully with patients, hospital or Xtend Employees
• Is able to work individually and as part of a team
• Possess ability to concentrate for long periods of time
• Proficient in numeracy skills
• Pays close attention to detail
• Must possess excellent grammar and spelling skills
• Proficient in knowledge and use of email and internet
• Possess above average knowledge of administrative procedures