Student Insurance & Coding Specialist - Student Health Services

TITLE

Student Insurance and Coding Specialist

JOB SUMMARY

This position serves as the primary insurance coding and billing specialist to maintain TWU compliance with U.S. Department of State and Student Health Insurance requirements. This position is also responsible for the University Student Health Insurance program; billing and insurance processes, including the monitoring of ICD-9, ICD-10 CPT and HCPCS codes for accuracy; and management of the Foreign Student Insurance enrollment and waiver process. Performs other complex administrative duties and provides support relative to cashiering and payment processing. A working knowledge of health insurance policies and procedures is required. Work is performed under the direction of the Assistant Director of Student Health Services as part of the health care team and performance evaluation is based upon completion of assignments and results obtained. The performance evaluation is conducted through the performance evaluation system and in accordance with the University Policies & Procedures.

ORGANIZATIONAL RELATIONSHIPS

Reports to: Assistant Director, Student Health Services

Supervises: May supervise Student Assistants

ESSENTIAL DUTIES - May include, but not limited to the following:

• Serves as student health insurance specialist with a vast knowledge and application of all aspects of health insurance claims filing for student health services.

• Reviews patient encounters for proper use of procedures codes/modifiers diagnoses codes.

• Utilizes CPT, ICD-9, ICD-10 and HCPCS manuals, and insurance policies to ensure accurate coding has been used to optimize reimbursement.

• Reads and understands payor specific billing requirements as outlined in procedure manuals, payor newsletters and internal communications and incorporates any updates.

• Reviews claim and account data and makes applicable corrections to ensure claims meet all payor specific compliance guidelines and accounts are accurate.

• Posts payments from Explanation of Benefits received and process insurance correspondence.

• Corrects rejected claims and files for reconciliation.

• Performs appeals processing tasks as required from insurance companies in time efficient manner.

• Consults outside physician offices and hospitals for claims and coverage information.

• Reviews proposed fee schedule and recommends necessary adjustments to Assistant Director of Student Health Services.

• Manages the administrative function of the Foreign Student Insurance Program.

• Educates parents, students, graduates and employees, etc. on the student insurance benefits and processes.

• Posts insurance premium charges to individual student accounts each semester for F1/J1 students.

• Evaluates multiple insurance policies to verify comparable coverage to TWU Student Insurance Plan and Department of State minimum requirements.

• Approves and denies waiver request forms and alternative insurance submissions after review for compliance with Federal regulations for all non-immigrant students.

• Processes credits to Student Accounts for insurance premium charges when Waivers are accepted, notifies student when waivers are denied.

• Consults with International students concerning their waiver request eligibility and insurance coverage.

• Addresses questions and concerns for individuals regarding waivers, plans, benefits, enrollment and claims settlement.

• Coordinates with insurance company plan administrators to clarify problematic situations, processing international student enrollment and premium payment.

• Conducts daily audits using Datatel system and Academic HealthPlans website to ensure enrollment and waivers have been processed and completed.

• Negotiates with health care providers and insurance company when errors occur in billing and student coverage.

• Effectively communicates with TWU departments (Bursar, International Office, Schools/Programs) concerning enrollment issues.

• Complies with applicable, laws regulations, policies, and procedures employing appropriate controls and sound financial/business practice.

ADDITIONAL DUTIES

• Coordinates campus-wide communication campaigns (orientation, emails, publications, website, etc.)

• Verifies that billing processes are compliant and accurate at timely intervals as required.

• Reconciles invoices, completes/submits checks requests, assembles/organizes data of complex nature and prepares/submits reports in required formats.

• Provides patients and clinic providers with lists of providers appropriate for insurance networks/benefits.

• Accepts payments from patients and processes timely and accurately.

• Schedules appointments for patients and provides documentation required for outside insurance.

• Assists with process improvement to optimize insurance enrollment and claim reimbursement.

• Makes necessary coding changes/updates in clinical management software when needed.

• Performs other duties as requested.

EDUCATION

High school diploma or equivalent required. Some College/associate's degree preferred. Successful completion and certification of coding program preferred.

EXPERIENCE

Two-year experience as an insurance/accounting clerk in a hospital or clinic environment, preferably the college health setting. Working knowledge of medical terminology. Working knowledge of insurance policies and procedures required.

REQUIREMENT

Regular and reliable attendance at the University during regular scheduled days and work hours is an essential function of this position.

All employees share the responsibility of maintaining information security and privacy requirements within the university by adhering to Federal and State regulations, and TWU Policies & Procedures.

KNOWLEDGE, SKILLS, AND ABILITIES - The following are essential:

• Working knowledge of insurance policies and procedures.

• Knowledge of medical terminology, ICD-9, ICD-10 and CPT coding.

• Ability to establish and maintain effective work relationships with students, faculty, staff and the public.

• Ability to organize work effectively, conceptualize and prioritize objectives, and exercise independent judgment based on an understanding of organizational policies and activities.

• Ability to communicate effectively orally, by phone, in person, and in writing.

• Ability to represent the department and University in a friendly, courteous, and professional manner.

• Ability to respond to emergency situations in a timely manner.

• Ability to use a personal computer and other office equipment, including related university software and email.

PHYSICAL DEMANDS

The physical demands described in the Essential Duties and below are representative of those that must be met by an employee to successfully perform the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

The employee may be required to travel.

WORK ENVIRONMENT

All employees are responsible for maintaining an environment that is free from discrimination, intimidation, harassment, including sexual harassment. Work is performed primarily indoors in an office and/or laboratory setting. Employees may be exposed to conditions that affect the respiratory system, such as fumes, odors, dusts, mites, gases, or poor ventilation. Employees are frequently exposed to contagious or infectious diseases.

SAFETY

TWU promotes a safe working environment. Employees are responsible for completing assigned tasks safely and efficiently, and supervisors are responsible for creating and maintaining a safe work environment. Employees must report any unsafe work conditions or practices, as well as any near-miss incidents, to their supervisor and Risk Management. Supervisors and employees should ensure that injury/accident reports are submitted to the Office of Human Resources and Risk Management within 24 hours of the incident.

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Texas Woman's University strives to provide an educational environment that affirms the rights and dignity of each individual, fosters diversity, and encourages a respect for the differences among persons. Discrimination or harassment of any kind is considered inappropriate.

Texas Woman's University is committed to equal opportunity in employment and education and does not discriminate on the basis of race, color, religion, gender, sex, sexual orientation, ethnic origin, age, veteran's status, or against qualified disabled persons.

All positions at Texas Woman's University are deemed security sensitive requiring background checks.

If you are a male between the age of 18 and 25, federal law requires that you must be registered with the U.S. Selective Service System, unless you meet certain exemptions under Selective Service law. Under HB 558, enacted by the 76th Texas State Legislature, if you are currently of the age and gender requiring registration with Selective Service, but knowingly and willfully fail to do so, you are ineligible for employment with an agency in any branch of Texas state government. For additional information regarding registration or status, you can contact the Selective Service System at 847-688-6888 or www.sss.gov.