As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care patients need to keep moving and keep enjoying their life. The Spine Insurance Specialist is responsible for performing accounts receivable for spine patients with excellent customer service while ensuring compliance and implementation of in and out-of-network policies. Essential Functions: · Verifying patients’ insurance eligibility, out of network benefits, and communicate policy to the patient · Understand LBJI’s out of network payment and negotiation policies and apply them to insurance claims · Research unpaid and denied insurance claims to ensure account resolution and claim payment · Verify accuracy and completeness of documentation included with paper claims prior to submission · Maintain strictest confidentiality adhering to HIPAA rules and regulations · Have an in-depth understanding of insurance rules and regulations, CPT/ICD10 coding information, explanation of benefits and company billing procedure(s) · Document all work in practice management system · Ensure accuracy to optimize reimbursement while adhering to regulations · Negotiate with third party networks while adhering to practice collection guidelines · Communicate with team member(s) and the Spine Billing Manager regarding billing issue(s), insurance process(es) and denial trends. Present problems to team with a solution-based approach · Meet and respond to patient requests for assistance and/or questions regarding financial accounts, insurance payment and patient balances · Understand company’s refund policies · Other duties as assigned Competencies: · Knowledge of state, federal and regional collection, and reimbursement laws · Knowledge of HIPAA compliance · Knowledge of CPT and ICD-10 codes · Knowledge of an Explanation of Benefits · Professionalism and work ethic Qualification: · Must be at least 18 years of age · Must have reliable transportation · Digital literacy · Medical terminology Minimum Education: High school diploma or the equivalent Preferred Education: Associates’ or Bachelor’s Degree Preferred Experience: Minimum of 2 years health insurance experience Required Skills: · Proactively identify and develop effective solutions · Cooperate with other individuals and departments · Complete assignments in a timely and satisfactory manner · Adapt well to changes in policy and job demands · Demonstrate professionalism with co-workers and the public · Contribute ideas to improve individual and practice performance · Determine the multiple tasks involved and prioritize their completion Physical Requirements: While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. The employee must occasionally lift and/or move up to 50 lbs. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job. Environmental/Working Conditions: Work is performed in an office environment. Involves frequent personal and telephone contact with patients and with testing sites and surgery departments. Work may be stressful at times. Interaction with others is constant and interruptive. Contact involves dealing with injured sick people. Compliance: All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete required compliance training modules, and report any observations of non-compliance. EEO Statement: We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.