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Patient Insurance Specialist (Journey)
University of North Carolina

Location: Greensboro, North Carolina
Work Setting: Educational Institution
Job Function:
HIM Specialist
Job Type:
Full-Time
Salary Range: $34,916 – $40,134

Introduction

UNC Greensboro, located in the Piedmont Triad region of North Carolina, is 1 of only 57 doctoral institutions recognized by the Carnegie Foundation for both higher research activity and community engagement. Founded in 1891 and one of the original three UNC System institutions, UNC Greensboro is one of the most diverse universities in the state with 20,000+ students, and 3,000+ faculty and staff members representing 90+ nationalities. With 17 Division I athletic teams85 undergraduate degrees in over 125 areas of study, as well as 74 master’s and 32 doctoral programsUNC Greensboro is consistently recognized nationally among the top universities for academic excellence and value, with noted strengths in health and wellnessvisual and performing arts, nursing, education, and more. For additional information, please visit uncg.edu and follow UNCG on FacebookTwitter, and Instagram.

Job Description

The mission of the Student Health Services is to enhance the physical, psychological, environmental, and health education status of UNCG students. As a health organization operating within an academic institution, the Student Health Services is committed to the support of the educational, research, and service missions of the University.

  • Processing insurance claims for students enrolled in designated insurance plans who receive covered services in the Student Health Services;
  • Providing insurance education and customer service to students, parents, Student Health Services staff, other campus departments, and other college health colleagues;
  • Receives and completes disclosures for authorization requests for medical records while using oral and written communication skills and adhering to HIPAA privacy regulations;
  • Maintain an accurate account of the number of documents received in document manager and assist in monitoring referral statuses in referral manager;
  • Verify insurance information claims processing by contacting the insurance companies, patients, and using eligibility tools provided by Waystar;
  • Assist in managing all activities associated with insurance requirement enforcement, insurance-related research, auditing and problem-solving, and other administrative duties as assigned.

Key Responsibilities

Financial Management — Insurance Claims Processing

  • Process all insurance claims in a timely and accurate manner, ensuring maximum payments.
  • Prepares insurance claims for processing by reviewing billing/render provider, ICD 10 diagnosis, and CPT procedures on the patient tickets in Medicat.
  • File insurance claims to clearinghouse with 96%-99% accuracy.
  • Reviews and implements claims policies using 30-60-90 day reconciliation for claims reports. Complete reconciliation of billed claims by the Insurance coders up to ensure maximum reimbursement.
  • Reconciles all medical claims submitted with Explanation of Benefits reported by third-party claims administrator. Researches insurance payment denials for resubmission of claims.
  • Transfer Employee Payroll deductions to Banner Human Resources module.
  • File Workers’ Compensation claims with UNC Designated carrier.
  • Gathers, monitors, analyzes, and records financial data; determines accuracy, validity and ensures compliance with standards, rules.
  • Calculate and count cash amount in a draw at the beginning and end of shift.
  • Reconcile shift and deposit funds according to the cash handling responsibility agreements signed by the students.
  • Reconciles daily sales activity and prepares credit and cash deposits at the end of the day.
  • Post all payments in Medicat Healthcare Information System, creating walk-out statements for each student/customer on the day of service.
  • Calculates student’s co-payments, deductibles, and co-insurance.
  • Review and process payments for billing to Insurance.
  • Receive and process payments added to student account if applicable.
  • Periodically complete surveillance of cash sales and register balance amounts

Business and Records Administration 

  • Uses established filing and data systems, functions, and/or procedures that require knowledge of the program.
  • Review data and information for completeness and accuracy using standard guidelines; performs tasks with attention to detail.
  • Reorganize Workers Compensation and staff paper medical charts.
  • The result should allow for ease in locating when such chart is requested and implemented by the end of the review cycle.
  • Look for different (but effective) solutions to problems or opportunities.
  • Monitor’s transmission of all electronic and/or manual claims.
  • Monitors electronic posting processes for accuracy and retrieves files and corrects errors when necessary.
  • Schedules appointments via telephone and face-to-face for medical clinics using Medicat’s practice management component.
  • Reschedule appointments for administrative reasons.
  • Assists with scheduling and training student customer service workers.
  • Check’s patients out after their medical appointment and pharmacy visits.
  • Enters update patients’ current insurance policy information in Medicat’s practice management component.
  • Provides directives to patients about insurance requirements and referral appointments scheduled on their behalf.
  • Provides feedback and input to assist in resolving any billing/coding problems.
  • Calculate and confirm students’ financial determination and ability to pay, input necessary data into system.
  • Completes third-party billing; reconciles reports; completes insurance forms.
  • Contacts outside medical providers to schedule appointments for SHS patients when referred by SHS medical providers.
  • Obtains medical information from outside sources needed for patient care.
  • Processes requests for release of medical information from a variety of requestors.
  • Retrieves patients’ medical information from Medicat electronic health records or inactive medical records.
  • Adheres to HIPAA, privacy, and security regulations.
  • Attend professional development training and participate in committees as assigned.

Information Processing and Decision-Making 

  • Uses insurance systems, vendors software, vendors manuals, and/or protocols to enhance the insurance departments.
  • Review data and information for completeness and accuracy using standard guidelines; performs tasks with attention to detail.
  • Understands software used to perform day-to-day functions.
  • Proofreads documents for grammar, spelling, punctuation, and basic formatting.
  • Demonstrates ability to handle confidential information when compiling and organizing clinical information to be scanned into the electronic health record.
  • Keep records in secure areas by maintaining confidentiality.
  • Identifies and recognizes problems that have established precedents and limited impact.
  • Refers non-standard questions and problems to higher levels.
  • Explains billing statements and various payment options for services.
  • Explains HIPAA and FERPA regulations regarding confidentiality and billing.
  • Look for different (but effective) solutions to problems or opportunities.  Sees problems as challenges and generates new ideas to overcome them.  Offers suggestions to improve work output.
  • Request Supervisor assistance with difficult balancing of night close process

Required Qualifications

Work Hors of Position:

8 AM – 6 PM Monday-Thursday; 8 AM – 5 PM Friday and 12pm-3 pm Rotating Saturday and Sunday

 

Competency

 

Competency Program Knowledge
Competency Description
Demonstrates in-depth knowledge of the area of specialization, the program, process, and/or organizational operation. May be the content/process resource.
Competency Level Journey
Competency Information/Records Administration
Competency Description
Coordinates varied records processing activities requiring the application and some interpretation of agency procedures, policies, laws, and regulations. Reviews information for completeness and accuracy using multiple guidelines.
Competency Level Journey
Competency Office Technology
Competency Description
Utilizes advanced training/knowledge; integrates varying software applications and systems for information and records purposes.
Competency Level Journey
Competency Problem Solving
Competency Description
Recognizes, defines, and resolves non-standard problems using operating procedures, research, practices, and established precedents. Resolves recurring issues and problems as well as some unique situations. Anticipates problems and develops recommendations for management resolution.
Competency Level Journey
Competency Communication (Verbal)
Competency Description
Presents ideas in a clear, concise, organized manner. Explains and interprets programs, policies, and procedures to meet the specific needs of staff and clients. Advises program staff/clients in all matters related to program operations.
Competency Level Journey
Competency Communication (Written)
Competency Description
Composes and organizes ideas logically, works in multiple formats such as letters, memos, reports, or presentations, and can change/adjust style to meet the needs of the program and audience. Reviews sensitive materials and edits content constructively.
Competency Level Journey

Preferred Qualifications

  • Health Information and electronic health record experience
  • College health experience
  • Knowledge of HIPAA

If no applicants apply who meet the required competency level and training & experience requirements, then management may consider other applicants. Salary would be determined based on competencies, equity, budget, and market considerations.

Education Qualifications

Bachelor’s degree in business administration or a related discipline; or an equivalent combination of training and experience. Associate degree and 3 years of related office experience and 3-5 years of medical record and/or insurance billing experience

 

Compensation/Benefits

Recruitment Range

$34,916 – $40,134

 

Benefits & Discounts Perks

Benefits

Discounts, Perks and Resources

Instructions for Resume Submission

Applicants must complete and submit an electronic application for employment to be considered. Resumes will not be accepted in lieu of completing an electronic application. The application must be completed in full detail for your qualifications to be considered.

Applicants are required to upload a list of at least three (3) professional references that includes:
    1. Name,
    2. Company Name,
    3. Type of reference (Professional, Supervisor, Colleague, Academic, or Personal). One (1) of those references will need to be a current or previous supervisor.
    4. Email Address
    5. Contact Phone Number

 

Applications are not successfully submitted until an online confirmation number has been received at the end of the application process.

Apply Online: https://spartantalent.uncg.edu/postings/20985

Posted: November 8, 2021 at 11:13 AM
Post ID: 64226

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