Insurance Specialist

Job Description

REQUIREMENTS

• Proven experience in medical coding, billing, or insurance claim processing within a healthcare setting
• Strong knowledge of ICD-9, ICD-10 coding systems and CPT coding procedures
• Familiarity with DRG classifications and their application in hospital billing processes
• Experience working with EMR/EHR systems and medical records management software
• Excellent understanding of medical terminology, healthcare documentation standards, and insurance reimbursement procedures
• Ability to handle sensitive patient information with confidentiality and professionalism
• Strong organizational skills with attention to detail to ensure accuracy in coding and billing tasks

RESPONSIBILITIES

• Review and interpret medical records to assign appropriate diagnosis codes (ICD-9, ICD-10) and procedure codes (CPT, DRG) for billing purposes
• Ensure accurate medical coding by applying knowledge of medical terminology, ICD coding systems, CPT coding, and DRG classifications
• Prepare and submit insurance claims using Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems, verifying all information for accuracy
• Follow up on unpaid or denied claims through effective medical collection strategies and communicate with insurance companies to resolve discrepancies
• Maintain detailed documentation of medical records, billing activities, and correspondence related to insurance claims
• Stay current with industry regulations, updates in ICD coding standards, and changes in insurance policies to ensure compliance
• Collaborate with healthcare providers and administrative staff to clarify documentation requirements and optimize billing processes

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