Location: Baton Rouge, LA
Company: Caresouth
programs (if applicable), informing the patients of any out-of-pocket (OOP) costs and /or processing payment arrangements. In addition, the Dental Insurance Coordinator will be responsible for obtaining referrals and/or authorizations for clinic services, ensuring accurate, and timely information exchange with clinical departments, and collecting data for routine reporting.
POSITION RESPONSIBILITIES: Knowledge and understanding of Employee Handbook. Carry out the meaning of the CSMD Mission and Vision statements. Practice a culture of safety to reduce or prevent risk of injury, claims, loss or liability by utilizing the Risk Management and Infection Control Plan. Perform responsibilities
with a high-quality standard to yield improved compliance, quality, and patient outcome measures by adhering to the Quality Improvement Plan. Be present and ready for work as scheduled.
Attend in-service trainings, departmental meetings, and community events. Work cohesively with team members. Greets patients, visitors, and staff in a courteous, friendly, and professional manner. ADMINISTRATIVE: Conducts interviews with patients and / or family members. Obtains and enters relevant current dental patient demographic information (i. e. address, phone numbers, insurance, etc. ) and service information upon each visit and enters into dental practice management software. Explains benefits
to dental patients as well as staff, as applicable. Obtains prior authorizations as applicable.
Assists eligible dental patients with completing Sliding Fee Applications. Transmits benefits applications to patients via email upon request to expedite verification processes. Provide patients and staff with insurance and clinic based financial program education through explanation of benefits and eligibility requirements. Conduct comprehensive patient interviews to backss eligibility for third-party payer benefits and clinic-based programs. Advises self-pay patients of their dental care options and refer to Outreach Enrollment Specialist, as needed. Send benefits applications to patients via email upon request to expedite verification processes.
Upload completed insurance verification forms. Respond to returned mail. Setup new hires with insurance login. BILLING/FINANCIAL: Set up arrangements / monthly installment plans for patients to payoff balances within the guidelines of CSMD collection policy. Verify insurance coverage and benefits via online access or by phone in advance of a patient's appointment. Posting payments made by patients. Following up on non-paid insurance claims. Managing late payments and overdue accounts (payment plans and / or promissory notes).
Processing insurance payments and refunds. Create, as applicable; implement, and utilize a quick reference guide for Medicaid plans. Respond to insurance carriers in a timely manner with requested additional documentation. Create, as applicable; implement, and utilize an online portal for insurance plans to verify plans. Disseminate Insurance Payers List to staff to ensure the accuracy of the Good Faith Estimates. Generate billing reports and monitor weekly, monthly, and quarterly to confirm payments from payers and patients. Build fee schedules based on contract rates and language as appropriately received through clearly defined method of communication (designated fax or email).
Maintain fee schedule updates and maintenance based on insurance carrier updates provided through clearly defined method of communication (designated fax or email). Work with third party administrators, as appropriately defined and connected, to ensure fee schedule builds will auto adjudicate and remediate pending claims associated with fee schedule data. Audit claims adjudication for compliance with contract rates and terms provided accurate payer information is available. Work with Billing and Credentialing Manager to ensure continued receipt of accurate and current payer information in order to perform other duties correctly.
Assists dental staff at satellite sites with eligibility issues. Provides backup coverage for Dental Patient Engagement staff as needed and works collaboratively with Dental Patient Engagement staff to provide excellent customer service to patients when answering calls and during check in and check out procedures. May perform appointment reminders and document the outcome/status in the Dentrix System, as directed. Maintain knowledge and expertise in eligibility, enrollment, and program specifications of the Ryan White program, Federal Marketplace, and other health coverage programs such as Healthy Louisiana (Medicaid and CHIP).
Maintains confidentiality of patient's protected health information. Identifies areas of improvement such as workflows and policies and processes. Answers the phones as required. Performs other duties as assigned. Arranges monthly installment plans for patients to payoff balances within the guidelines of CSMD collection policy. REQUIREMENTS Certificate in Medical Office Administration with three years of relevant experience OR an Associate's degree in health care, accounting or related field with two years of relevant experience.
Bachelor's degree preferred. Must have a s trong understanding of all major health insurance carriers, knowledge and experience working within insurance companies; must have strong computer, basic math, and decision-making skills. Excellent verbal and written communication skills. Must have exceptional interpersonal communication skills. Must be able to effectively resolve conflicts. Demonstrated professionalism in dealing with confidential and sensitive patient information. Comfortable discussing financial matters and asking for/requesting payment on past due accounts.
Detail-oriented with ability to effectively prioritize tasks in a fast-paced environment Must have superior communication skills (reading/written/verbal) and organizational skills. Exhibit a high level of courtesy, tact and poise with interacting with patients, co-workers, other internal customers, visitors and healthcare professionals. Cash management experience in order to process and request payments. Excellent computer skills, experience with Electronic Health Record system preferred. Able to work independently and as part of a team.
Ability to sit for long periods and communicate over telephone while using computer. Performs all job responsibilities in full compliance with all applicable laws, rules, regulations, policies and procedures. SUPERVISES N/A Physical Requirements: Visual acuity - always Hand - eye coordination - always Lifting approximately 10-15 lbs. Pushing, Pulling - sometimes Stooping, Bending, and Standing - sometimes Walking- frequent; short distances WORK ENVIRONMENT: Indoor, environmentally controlled Exposure to disease or infections No vibrations Exposure to artificial and/or natural light Exposure to outdoor weather elements TRAINING Relias Track A Non-Clinical Relias Care South Onboarding PERFORMANCE MANAGEMENT EVALUATION TYPE Operations
positive work culture for your co-workers? If so, apply today! Position Summary: Incumbent will be r esponsible for the account receivable of assigned payors. Must have a good working knowledge of overturning denials, addressing credit balances and working in a paperless environment.
Minimum Job Qualifications: High School graduate. Must have a minimum of 3-5 years of experience in a medical billing office and collections. Knowledge of Medical Terminology and MS Outlook and Excel. Additional Job Qualifications: Must be detail-oriented, organized and able to manage multiple projects and priorities. Must be knowledgeable in medical billing and collections and have the ability to handle
a high volume of accounts. Must have good written and verbal communication skills. Must have a positive attitude and a team player. DUTIES AND RESPONSIBILITIES: Collects on outstanding claims for assigned payors Researches denials and refiles corrected claims as well as researching unprocessed claims.
Researches and refunds credit balances for assigned payors Monitors reimbursement for assigned payor assuring contracted fee schedules are being followed. Reports any issues with claims processing such as bundling, charge limits, etc. Issues an appeal to payors for any claims processed incorrectly Comments collection activity on patient's account. Backs up for cash posting and customer service
department when necessary. Maintains access to any website associated to assigned payors Maintains access to hospital sites.
Establishes contact with representatives for the assigned payors Collaborates with other team members and management as needed Performs other duties as assigned
positive work culture for your co-workers? If so, apply today! PART TIME POSITION Position Summary: Incumbent will be r esponsible for the account receivable of assigned payors. Must have a good working knowledge of overturning denials, addressing credit balances and working in a paperless environment.
Minimum Job Qualifications: High School graduate. Must have a minimum of 3-5 years of experience in a medical billing office and collections. Knowledge of Medical Terminology and MS Outlook and Excel. Additional Job Qualifications: Must be detail-oriented, organized and able to manage multiple projects and priorities. Must be knowledgeable in medical billing and collections and have the
ability to handle a high volume of accounts. Must have good written and verbal communication skills. Must have a positive attitude and a team player. DUTIES AND RESPONSIBILITIES: Collects on outstanding claims for assigned payors Researches denials and refiles corrected claims as well as researching unprocessed claims.
Researches and refunds credit balances for assigned payors Monitors reimbursement for assigned payor assuring contracted fee schedules are being followed. Reports any issues with claims processing such as bundling, charge limits, etc. Issues an appeal to payors for any claims processed incorrectly Comments collection activity on patient's account. Backs up for cash posting
and customer service department when necessary. Maintains access to any website associated to assigned payors Maintains access to hospital sites.
Establishes contact with representatives for the assigned payors Collaborates with other team members and management as needed Performs other duties as assigned
Please refer to the? Job Specifications? tab located at the top of the LA Careers? Current Job Opportunities? page of Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level. Applicants must have Civil Service test scores for 8100-Professional Level Exam in order to be considered for this vacancy unless exempted by Civil Service rule or policy.
If you do not have a score prior to applying to this posting, it may result in your application not being considered. Applicants without current test scores can apply to take the test here. To apply for this vacancy, click on the? Apply? link above and complete an electronic application,
which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process.
Further status message information is located under the Information section of the Current Job Opportunities page. Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete. For further information about this vacancy contact: Lori G. Blair Louisiana Department of Insurance P. O. Box 94214Baton Rouge, LA Qualifications MINIMUM QUALIFICATIONS: A baccalaureate degree. SUBSTITUTIONS: Six years of full-time
work experience in any field may be substituted for the required baccalaureate degree only.
Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows: A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree. 30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree. 60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree. 90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree. College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience to substitute for the baccalaureate degree. NOTE: Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.
Job Concepts FUNCTION OF WORK: To regulate and enforce statutory laws relative to the insurance industry. LEVEL OF WORK: Entry. SUPERVISION RECEIVED: Direct from Insurance Supervisor or other higher-level personnel. SUPERVISION EXERCISED: None. LOCATION OF WORK: Department of Insurance. JOB DISTINCTIONS: Differs from Insurance Technician 2 by presence of professional level duties Differs from Insurance Specialist 2 by the complexity of duties.
Examples of Work EXAMPLES LISTED BELOW INCLUDE BRIEF SAMPLES OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. PLEASE NOTE THAT NOT ALL TASKS ARE INCLUDED. Communicates by telephone, correspondence, and/or meetings with company filing officials, government representatives, attorneys, private individuals, policyholders, professional associations, and the public regarding: rate filing information submitted or required; state insurance laws regulations and directives; licensing laws, rules, and regulations; examinations for licensing; and insurance company appointments.
Researches data of submissions from insurance companies involving use of rules and rates through the aid of computer and physical files; researches insurance laws, analyzes legal information and insurance contracts, renders decisions and composes correspondence to interested parties pertaining to insurance inquiries and complaints, and conducts formal investigations regarding these inquiries and complaints. Compares filing requests with other filings, approved and disapproved, for similarities in rules and rates requested; reviews insurance policy forms and contracts for compliance with Louisiana Insurance Code, recommending approval or disapproval thereon; analyzes rule and rate filings submitted by insurance companies to backss appropriateness of requested changes and fairness to consumers.
Attends departmental hearings to give testimony based on investigative findings. Cooperates with public agencies and private organizations in efforts to prevent, detect, and prosecute fraudulent insurance transactions. Maintains familiarity with the Insurance Code and departmental rules and regulations which govern the administration of the insurance examinations.
Maintains several rating manuals for various lines of insurance.
Insurance jobs refer to a variety of roles within the insurance industry, including positions such as actuaries, underwriters, claims adjusters, insurance agents, and customer service representatives. These jobs are characterized by their focus on evaluating risks, determining policy terms, managing claims, selling insurance products, and providing customer support. Notable features of insurance careers include a blend of analytical and interpersonal skills, opportunities for professional growth, and the importance of staying updated with legal and regulatory changes. Insurance professionals often play a crucial part in helping individuals and businesses mitigate financial risks through tailored insurance solutions.
