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Role Description
The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement.
- Understand and work accounts throughout the entire revenue cycle
- Prepare and submit claims to payers either electronically or by paper
- Secure necessary medical documentation required or requested by payers
- Proactively identify and perform account follow-up on outstanding insurance balances
- Take necessary action for account resolution in accordance with established federal and state regulations
- Complete work within authorized time to assure compliance with departmental standards
- Keep updated on all state/federal billing requirements and changes for insurance types
- Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims
- Process and resolve denials
- Use advanced knowledge and understanding to process payer rejections
- Conduct trend analyses, appeals and resolve low payment or underpaid accounts
- Provide input for payer-specific meetings
- Handle difficult account situations and resolve issues delaying or preventing payments from payers
- Perform miscellaneous job related duties as requested
- Demonstrate accuracy in correcting and submitting claims to payers
- Ensure accounts are billed in a timely manner
- Report to a manager any accounts that cannot be finished in a timely manner
- Utilize the correct resources to ensure the completion of disputed claims
- Follow claims through the entire billing process
- Ensure all claims meet compliance regulations
- Use appropriate resources and channels to problem solve issues
- Input data accurately into the computer system
- Answer the telephone courteously
- Maintain and update computer skills as needed for work assignments
- Utilize software applications for maximum efficiency
- Ensure verbal communication is courteous, complete, and professional
- Ensure written communication is accurate, complete and professional
- Identify and promptly resolve billing complaints
- Direct issues to supervisor when unable to resolve
- Document in computer system all contacts regarding patient accounts
- Verify demographics, identify appropriate third-party insurance/payers, set up insurance, initiate patient financial assistance
- Contact the insured or financially responsible party to obtain missing information
- Verify, create or update patient accounts for billing, prepare insurance claims forms or related documents, and verify completeness and accuracy
Qualifications
- High school diploma or equivalent preferred
- Post-secondary or trade courses in accounting, business, and communications would be helpful
- Six months’ related work experience required
- Computer skills essential
- Leadership may require related experience to the Associate Insurance Representative for internal applicants
Company Description
Sanford Health, one of the largest health systems in the United States, is dedicated to the integrated delivery of health care, genomic medicine, senior care and services, global clinics, research and affordable insurance.
- Headquartered in Sioux Falls, South Dakota
- Includes 44 hospitals
- 1,400 physicians
- More than 200 Good Samaritan Society senior care locations in 26 states and nine countries
#Insurance #Representative
