Base Pay Range:

Job Description:

The Insurance Specialist II, will work complex inpatient/outpatient claims, including procedures and surgeries, to secure reimbursement from governmental and private payors.

This position is Full Time, Monday-Friday 7am-3:30pm with a half an hour lunch. The work location will be at our business center located in the hospital district near downtown Spokane, with free parking. This position does have the potential of being a hybrid (combination of in office and work from home) following training.   

Summary:  Address large volume of unpaid or incorrectly paid/denied claims to secure reimbursement.

General Description:  Performs medical billing functions as related to both professional and outpatient surgery claims. Reviews and resolves claim edits and rejections and resubmits clean claims. Reviews unpaid claims, including denials, and appropriately resolves and resubmits adjusted/corrected claims. Research and/or resolves overpayments/credit balances.

Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Responsible for all phases of billing to government and commercial insurers, including initial billing of clean claims electronically or on paper, subsequent follow up on unpaid claims to the point of payment or resolution of the claim, and resolving credit balances.       
• Prioritizes assigned worklist of aged accounts appropriately and works on aging accounts to their resolution.
• Reviews and processes electronic claims, claim edits and deletions appropriately and compliantly.
• Interprets billing regulations accurately and within federal, state, and third-party billing regulations and policies.
• Utilizes various client host systems in order to research and rebills claims.
• Verifies reimbursement to make sure payers are reimbursing according to fee schedule

• Other special projects and duties as assigned.

General Duties and Responsibilities:

• Ability to maintain strict confidentiality within the Inland Imaging companies and Inland’s customers.
• Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.
• Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.
• Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.
• Honest, pleasant manner and good personal hygiene.
• Free of alcohol and drug abuse.
• Valid state driver’s license and proof of insurance.
• Excellent communication and interpersonal skills.
• Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
• Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
• Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.

• Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
• Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
• Performs other duties as required by displaying team spirit and self-growth, accepting, and performing other projects and responsibilities, and requesting other projects and responsibilities.
• Quarterly quality assurance meeting attendance is required for this position.
• Attendance is a requirement for this position.
• Rotates to other shifts and locations as needed.
• Performs other special projects and duties as assigned.

Supervisory Responsibilities:

• There is little or no supervisory responsibility in this position

Advocacy:

Treats all clients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values:

• Show We Care, Do The Right Thing, Maximize Individual Potential, Always Aim Higher

Qualifications:  

• Education: High School Diploma/GED required.
  • Two-year medical billing course successful completion is desired.
• Experience: At least five years of experience in billing medical claims to either government or commercial insurers.  Preferably has experience in billing Pluvicto, Y-90, Lutathera, Kyphoplasty, but will accept equivalent in physician, clinic, or ASC billing.
  • Working knowledge of government hospital payment methodologies including OPPS, Critical Access Hospital method II, or both preferred.
  • CPT, HCPCs and ICD-10 coding experience preferred.
  • Experience with electronic claims scrubbing and clearinghouse systems preferred.
• Licensure:   N/A
• Certifications:  A certification related to healthcare claims processing from a recognized industry accrediting body (AHIMA, AAPC, etc.) desired, but not required
• Computer Skills:  Experience with the following computer applications is highly desired: Microsoft Office products (Outlook, Word, Excel), Internet/Intranet, Meditech, Epic or other hospital or physician EHR/accounting system.
• Must be willing to work in office with possibility of hybrid
• Background Check:
  • Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
  • In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG).  Employees must not be included on this list.  
• Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test which includes marijuana.

Nuvodia/Inland is an EEO employer...