"Alerted.org

What We Offer

Insurance Specialist Remote: Monday - Friday

Hours: 8AM - 5PM

1. EPIC Knowledge

EPIC is an Electronic Health Record (EHR) and Revenue Cycle Management (RCM) system widely used in healthcare organizations.

Key areas of EPIC knowledge for follow-up or denials work include:

+ Workqueues (WQs):

+ Navigating Account, Claim, and Follow-up WQs.

+ Prioritizing accounts based on age, balance, or payor.

+ Using filters to identify Denied, No Response, or Pending claims.

+ Account Review:

+ Accessing Account Summary and Guarantor Summary.

+ Reviewing Claim Information and Remittance Advice.

+ Checking Charge Review and Claim Edit workqueues for holds or rejections.

+ Follow-Up Actions:

+ Adding Notes, Ticklers, and Follow-up Dates.

+ Documenting payor communication accurately.

+ Initiating Claim Rebill or Correction workflows.

2. Follow-Up Experience

Follow-up (A/R Follow-Up) ensures claims are paid timely and correctly.

Core Responsibilities:

+ Reviewing unpaid or denied claims in EPIC.

+ Contacting insurance payors via phone or online portals.

+ Researching reasons for nonpayment or underpayment.

+ Submitting corrected claims, appeals, or additional documentation.

+ Coordinating with coding, charge entry, or utilization review teams as needed.

+ Tracking aging A/R and ensuring resolution per payor guidelines.

Key Skills:

+ Strong analytical and problem-solving ability.

+ Knowledge of billing codes (CPT, HCPCS, ICD-10).

+ Understanding of payer-specific claim formats (CMS-1500, UB-04).

3. Payor Guidelines and Denials

Understanding Payor Guidelines is critical for minimizing denials and maximizing reimbursement.

Common Denial Categories:

+ Eligibility/Authorization Issues: Missing or invalid authorization or coverage lapse.

+ Coding/Billing Errors: Incorrect CPT, modifier, or diagnosis codes.

+ Medical Necessity Denials: Documentation doesn’t support the service billed.

+ Timely Filing Denials: Claim submitted after payer’s deadline.

+ Coordination of Benefits (COB): Primary/secondary insurance not billed correctly.

Follow-Up Actions:

+ Verify eligibility and authorization dates.

+ Review denial reason codes (CARC/RARC).

+ Submit corrected or appealed claims per payer timelines.

+ Maintain documentation for audit readiness.

4. Commercial Guidelines Knowledge

Each commercial payor (e.g., Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield, Humana) has its own billing and reimbursement policies.

What You'll Do

It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time.

+ Our team members are part of an environment that fosters team work, team member engagement and community involvement.

+ The successful team member has a commitment to leveraging diversity and inclusion in support of quality care.

+ All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm".

What We're Looking For

+ Education: High School Diploma or GED, required. 2 Year / Associate Degree, preferred.

+ Experience: Minimum two years in medical billing or hospital coding, as a claims processor, medical claims for an insurance carrier, or Clerical/Billing experience in a medical office; preferred.

+ Additional Skills Required:

+ Excellent communication and organizational skills required. Ability to successfully complete generic and department specific skills validation and competency testing.

+ Must display excellent customer service skills and excellent computer skills.

+ Must be able to multi-task and be a team player.

+ Must be able to work overtime as required.

+ Must be self motivated, able to work independently without constant supervision and a critical thinker.

+ Must be flexible, able to meet deadlines and adaptable to change.

+ Ability to communicate effectively and professionally.

+ Detail oriented and strong organizational skills.

+ Aware of HIPAA laws.

+ Familiar with Microsoft Office Applications.

+ Must be able to manage time with tasks assigned.

+ Additional Skills Preferred:

+ Basic medical terminology.

+ Insurance guidelines.

Job Opening ID

95157