Insurance Representative

Role Overview

• The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement.
• Prepares and submits claims to payers either electronically or by paper.
• Secures necessary medical documentation required or requested by payers.
• Proactively identifies and performs account follow-up on outstanding insurance balances and takes the necessary action for account resolution in accordance with established federal and state regulations.
• Completes work within authorized time to assure compliance with departmental standards.
• Keeps updated on all state/federal billing requirements and changes for insurance types within area of responsibility.
• Understands edits and appropriate department procedures to effectively submit and/or correct errors on claims.
• Processes and resolves denials.
• Uses advanced knowledge and understanding to process payer rejections.
• Conducts trend analyses, appeals and resolves low payment or underpaid accounts.
• Provides input for payer-specific meetings.
• Handles difficult account situations and resolves issues delaying or preventing payments from payers.
• Performs miscellaneous job related duties as requested.

Requirements

• High school diploma or equivalent preferred; post-secondary or trade courses in accounting, business, and communications would be helpful for this position.
• Six months' related work experience required.
• Computer skills essential.