Medical insurance specialist job description

This post includes 3 parts: duties list, job qualification and job description writing tips for Medical insurance specialist in details. A complete job description concludes Medical insurance specialist key duties/responsibilities, Medical insurance specialist job qualifications (knowledge, education, skills, abilities, experience…KSA model) and other ones such as daily tasks, key activities, key/core competencies, job functions/purpose…

I. List of Medical insurance specialist duties:

1. Verify patient eligibility and resolve any problems
2. Contact customers to verify insurance information
3. Contact insurance companies to resolve payment issues
4. File appeals for denied claims
5. Correct claims for resubmission
6. Assists with monthly close functions
7. Follow up on unpaid claims
8. Identifies 1st, 2nd and 3rd party payer
9. Prepares claims as needed
10. Ability to meet individual and team goals with minimal errors as assigned by the Billing Manager Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
11. Participates in educational activities and attends weekly staff meetings
12. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations

II. List of Medical insurance specialist qualifications

1. Bachelor's Degree in Business, Health Care or related field preferred. Relevant combination of education and healthcare experience will be considered.
2. Minimum one year handson credentialing/provider enrollment experience in a healthcare setting such as a physician practice, hospital, or managed care setting, to include familiarity with practitioner enrollment, credentialing or network services experience
3. An understanding of billing and claims payment system requirements as related to practitioner enrollment is preferred.
4. Knowledge of the CAQH Datasource
5. Experience with MS Office; especially Excel and Access.

III. Tips to write job description

1. Too-long job description:

Looking at a too-long job description can frighten the candidates off and drive the away. A job description, no matter how important the job is, should not be included in more than 3 pages. If one focuses on too many things at a time, he shall definitely lose focus on the main items and get overwhelmed by the remaining; So, keep it concisely.

2. Too-short job description:

While too-long can be a problem, too-short is more a problem. It will ruin the meaning of the job description. A too-short one means it lacks necessary details and therefore, the candidate will not be able to understand while reading it.

3. Listing unnecessary functions or job duties:

Just classifying these into the “others” category will save you a lot of effort and space. On the other hand, the job description will become more dilute and easy to be neglected.

4. Key functions

Not listing key functions as required for the job can be a fatal mistake to a job description.

5. Grammar and spelling

Poor grammar and having spelling errors can ruin the job description, too. Never think that as you are the employer, you may have the right to make grammar or spelling errors while requires other not to. A job description with such errors is easily to be mistaken as a fake or ghost ads; as a result, the candidate will turn away from it.

6. Not specific enough:

Be specific and concise; if you don’t address the specific, then what the job description is for. It is for the candidate to understand just exactly what he needs to do or needs to have. Lacking details can confuse the candidates very well.

7. Not having the job description reviewed by others:

This is also a common mistake. One may be subject to bias, but more than one, especially with the help of those external advisor, the job description can be more perfect.

8. Using buzzwords or abbreviations:

In fact, it is not necessary at all to use such in a job description.

9. Using slang or legal words:

Just use common wording to communicate with others and don’t do anything extraordinarily.

10. Not updating the job description:

The same job may require different duties and responsibilities in different times, so, you cannot use the same job description for 2 different times.

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