PRIMARY PURPOSE:
This position will play a crucial role in assisting patients with understanding their insurance coverage, navigating complex insurance systems, and facilitating billing processes with the reimbursement team.

1. Performs all assigned duties in compliance with internal SOPs and external regulations. Brings compliance issues to the attention of management.

2. Assure high-quality customer service to all customers.

3. Maintains good attendance and punctuality per the absence policy.

4. Assess patients' insurance coverage and benefits to determine eligibility for services offered at the medical clinic.

5. Guide patients through the insurance process, including explaining benefits, coverage limitations, and out-of-pocket expenses.

6. Verify insurance coverage & benefits and obtain pre-authorization for medications, medical procedures, and services as required by insurance providers.

7. Maintain accurate and detailed records of insurance information, authorizations, and communications with insurance companies.

8. Collaborate with the billing department to ensure accurate coding and billing practices, including resolving any insurance-related issues or denials.

9. Educate patients, families, and clinic staff on insurance-related matters, including changes in coverage, policy updates, and billing procedures.

10. Keep abreast of changes in insurance regulations, policies, and procedures to ensure compliance and provide accurate information to patients and staff.
PATIENT BILLING SPECIALIST Page 2

11. Address insurance-related inquiries and concerns from patients, staff, and insurance companies promptly and professionally.

12. This role may also encompass additional tasks as assigned to ensure comprehensive support for patients and efficient operation of the insurance navigation process.

13. Performs all other duties, at the discretion of management, as assigned.
Add any department specific assignments or tasks in the spaces provided on the Department Specific Task List and attach to the Job Description for filing.

REQUIREMENTS:
Knowledge/ Education
1. High School Diploma or GED required.
2. Bachelor’s degree in healthcare administration, business administration, or related field preferred.
3. Strong understanding of medical coding and terminology required.

Experience
1. Two years of experience working with insurance navigation, medical billing, or healthcare administration required.

Skills/Abilities
1. Ability to provide exceptional customer service with particular regard to sensitive information.
2. Effective oral, written, and digital communication skills.
3. Must possess the skills and abilities to successfully perform all assigned duties and responsibilities.
4. Must be able to maintain confidentiality.
5. Motivated to stay updated on the ever-changing healthcare insurance landscape.

Knowledge/ Education
1. High School Diploma or GED required.
2. Bachelor’s degree in healthcare administration, business administration, or related field preferred.
3. Strong understanding of medical coding and terminology required.

Experience
1. Two years of experience working with insurance navigation, medical billing, or healthcare administration required.

Skills/Abilities
1. Ability to provide exceptional customer service with particular regard to sensitive information.
2. Effective oral, written, and digital communication skills.
3. Must possess the skills and abilities to successfully perform all assigned duties and responsibilities.
4. Must be able to maintain confidentiality.
5. Motivated to stay updated on the ever-changing healthcare insurance landscape.