The role you play

  • Embracing our mission to humanize healthcare
  • Living our Tegria values-being real, serving intentionally, and stepping in and stepping up
  • Working independently, as well as collectively to help ensure service level agreements are being met
  • Effectively utilizing communication channels, decision-making, and escalation pathways
  • Managing a high volume of inbound and outbound calls promptly
  • Identifying Contractual and Administrative Adjustments
  • Researching insurance billing and adjustment identification
  • Making calls addressing insurance claims and insurance follow-up
  • Reviewing and interpreting Contractual Terms for Managed Care, Commercial, Medicare, Medicaid, and Workers’ Compensation
  • Keeping records of all conversations in our call center database in a comprehensible way
  • Frequently attending educational seminars to improve knowledge and performance level
  • Obtaining supporting documentation regarding insurance follow-up efforts
  • Meeting personal/team qualitative and quantitative metrics

Success criteria

People who are successful as an Insurance Services Specialist for the Patient Services Department, display the following:

  • Are independent and managed accounts individually
  • Are goal-oriented, enthusiastic about problem solving, and organized
  • Flexible and comfortable with call que
  • Deliver proper outcomes/account resolutions within policy and procedures
  • Communicate effectively and efficiently with internal and external stakeholders
  • Can anticipate issues and escalate effectively. Believe they have input and the ability to influence a positive outcome for the patients/clients
  • Are adaptable and flexible – willing to adjust their approach to the scenario. Are willing to push their comfort zone and be a team player
  • Make commitments – and keep commitments

What we're looking for

We expect:

  • 2+ years of work experience as an insurance follow up representative
  • Thorough knowledge of insurance follow-up processes involving Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial Practices
  • Thorough knowledge and understanding of HIPAA and PCI protocols
  • Thorough knowledge of EOBs (explanation of benefits), CPT, ICD-10 codes, HCFAs, UB04s, HCPCS, DRGS, insurance contracts, and authorizations/referrals
  • Basic knowledge of medical terminology (e.g. primary care, provider, benefits, EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs, and authorizations/referrals)
  • Demonstrate ability to learn and stay abreast of relevant policies
  • Demonstrate ability to write and communicate effectively
  • Capable of and comfortable with working remotely (if applicable)

We'd love to see:

  • Proven success with driving outcomes for proper account resolution
  • Enjoys problem solving
  • Complete understanding of insurance contracts, inventory, credit reviews, and appeals
  • Deep knowledge of HIPAA and PCI protocols
  • Basic knowledge of medical terminology (e.g. primary care, provider, benefits, EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs, and authorizations/referrals)
  • Experience with navigating EPIC to research corresponding billing information for procedure codes, diagnostic codes, charge amounts, etc.
  • Experience with navigating EPIC to review associated patient’s demographics, and/or medical records
  • Experience with navigating Availity and Navinet to review eligibility and claim status
  • Experience with navigating CUBS System to manage and process patient accounts
  • Proven ability to manage 45 claims daily
  • Experience in a call center environment

Need a few more details?

Non-Exempt

Must be legally authorized to work in the United States without sponsorship.

10713 West Sam Houston Parkway North, Houston, TX 77064

Minimal (less than 10%)

Eligible

Now, a little about us …

At Tegria, we bring bold ideas and breakthroughs to improve care, technology, revenue, and operations in ways that move healthcare organizations from patient-centered to human-centered. We are helping healthcare put people first—both patients and those who dedicate their lives to delivering care. 

And at the very core of this vital work is our incredibly talented people.  

People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity. We’re real. We’re nimble, and we believe in our mission to humanize healthcare.  

Perks and benefits

Top talent deserves top rewards. We’ve carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.

  • Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
  • Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
  • And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls

Tegria is an equal employment opportunity employer and provides equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Tegria will provide reasonable accommodations for qualified individuals with disabilities. All qualified candidates are encouraged to apply. 

Job ID:

ACC-1000

View full job description as PDF

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