Insurance Representative

INSURANCE REPRESENTATIVE

CHARACTERISTICS OF WORK:

This is professional/clerical work involving the submission, collection, and follow-up of patient insurance claims.  Work includes customer service with patients, insurance companies, as well as other outside entities, and assisting with claims resolution.

MINIMUM QUALIFICATIONS:

• Computer skills
• Phone etiquette
• Interpersonal skills
• Insurance claims experience
• Insurance claims reporting
• Hospital and/or medical facility setting work experience

ESSENTIAL FUNCTIONS:

• Follow-up on all outstanding insurance accounts within a timely manner.
• Research denials/underpayments/rejections and requests/inquiries from insurance payers within standard billing cycle timeframe.
• Submit corrected claims and process all claim appeals.
• Ensure appropriate supporting documentation is received and complete to ensure accurate and timely processing of claims.
• Research and perform all secondary billing.
• Possess full understanding of EOBs to ensure payment accuracy and compliance with contract discount.
• Review and recommend claims for adjustment/write off to management.
• Communicate with payers about re-filing claims that were underpaid due to plan/provider errors. Use tracking system to follow up on re-filed claims with plans to ensure complete resolution.
• Researching insurance credits and insurance refund requests
• Other duties as assigned and directed by team management.

EXPERIENCE / EDUCATIONAL REQUIREMENTS:

Education:

Graduate of four-year high school or equivalent (GED).

Experience:

One year experience related to the described duties.