Insurance Fraud Investigator Jobs in Spring, TX (NOW HIRING)

Company Description
Our Services are focused on helping organization attain their goals by finding and placing superior personnel in your critical positions. At Orbit we are committed to help all of our stakeholders succeed.
Job Description
GENERAL SUMMARY OF DUTIES:
Responsible for entering and coding patient services into our electronic medical record system. Sorts and files paperwork, handles insurance claims, and performs collections duties.
Primary responsibilities
Translate patient information and into alphanumeric medical code.
Collect, post, and manage patient account payments.
Submit claims to insurance.
Prepare and review patient statements.
Review delinquent accounts and call for collection purposes.
Process payments from insurance companies.
Maintain strict confidentiality.
Code patient services and enter into computer.
Sort and file paperwork.
Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding.
Follow up to see if a claim is accepted or denied.
Investigate rejected claim to see why denial was issued.
Investigate insurance fraud and report if found.
Qualifications:
Education: High School or Equivalent;
Experience: 3 years preferred but not required.
License: N/A
Certification: Certified Professional Coder, Medical Billing and Coding Certificate, Certified Coding Associate, Certified Billing and Coding Specialist, and/or American Academy of Professional Coders, preferred but not required.
Special Skills: Basic computer Knowledge; Microsoft Office, Communication skills, Medical Billing and Coding, and Medical Terminology.
ESSENTIAL JOB FUNCTIONS:
Coordinate the functions related to billing and customer service.
Daily decisions and actions demonstrate a high level of engagement and sense of job ownership regarding desired business outcomes - high patient satisfaction and optimal productivity..
Apply experience and judgment to make decisions or resolve issues within standard guidelines and protocols.
Organizes the work processes to promote efficient flow.
Maintains working knowledge of regulations and standards specific to the clinic(s), including Medicare service and billing regulations.
Coordinate auto-posting and manual accounts receivable posting.
Communicates and supports policies and procedures appropriate for practice.
Collects delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur.
Utilizes collection agencies and small claims court to collect accounts by evaluating and selecting collection agencies; determining appropriateness of pursuing legal remedies; testifying for the hospital in court cases.
Maintains Medicare bad-debt cost report by tracking billings; monitoring collections; compiling information.
Initiates claims against estates by monitoring deaths and unpaid accounts; informing legal department to act on probate and estate issues; following-up with clerk of court.
Secures payments by interviewing and obtaining information from pre-surgery patients; establishing payments due prior to surgery.
Maintains quality results by following standards.
Updates job knowledge by participating in educational opportunities.
SKILLS:
Skills and confidence to be self-directed and take initiatives to function within the scope of the practice.
Excellent verbal and written communication skills.
Skill in understanding of patient education needs, as it pertains to patient balances by effectively sharing information with patients and families.
Skill intact and diplomacy in interpersonal interactions.
1+ years of supervisory experience, preferably in a healthcare center preferred.
Legal Compliance, Quality Focus, Productivity, Time Management, Organization, Attention to Detail, documentation Skills, Analyzing Information, General Math Skills, Resolving Conflict
ABILITIES:
Ability to learn and retain information regarding patient billing policies and procedures.
Ability to project a pleasant and professional image.
Ability to plan, prioritize and complete delegated tasks.
Ability to demonstrate compassion and caring in dealing with others.
Ability to be a contributing team player.
Ability to maintain confidentiality in all areas.
Qualifications
Skills and confidence to be self-directed and take initiatives to function within the scope of the practice.
Excellent verbal and written communication skills.
Skill in understanding of patient education needs, as it pertains to patient balances by effectively sharing information with patients and families.
Skill intact and diplomacy in interpersonal interactions.
Legal Compliance, Quality Focus, Productivity, Time Management, Organization, Attention to Detail, documentation Skills, Analyzing Information, General Math Skills, Resolving Conflict
Additional Information