Insurance Representative
Sanford Health
full-time
Posted on:
Location Type: Remote
Location: North Dakota • South Dakota • United States
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Salary
💰 $16 - $26 per hour
Job Level
About the role
- The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement.
- Must understand and be able to work accounts throughout the entire revenue cycle.
- 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.
- Consistently demonstrates accuracy in correcting (identified through pre-edits) and submitting claims to payers.
- Ensures accounts are billed in a timely manner.
- Consistently reports to a manager any accounts that cannot be finished in a timely manner.
- When claims are disputed, consistently utilizes the correct resources to ensure the completion of the claim.
- Accurately and completely follows claim through entire billing process.
- Ensures all claims consistently meet compliance regulations.
- Demonstrates accountability by consistently using appropriate resources and channels to problem-solve issues.
- Consistently demonstrates ability to input data accurately into the computer system.
- Consistently answers the telephone courteously.
- Maintains and updates computer skills as needed for work assignments.
- Demonstrates the ability to utilize software applications for maximum efficiency.
- Consistently ensures verbal communication is courteous, complete, and professional whether using phone or personal contact.
- Consistently ensures written communication is accurate, complete and professional in presentation whether word processing or using email.
- Identifies and promptly resolves billing complaints.
- Directs issues to supervisor when unable to resolve.
- Documents in computer system all contacts regarding patient accounts.
- Depending on location, may 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.
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.
- When applicable and if desired, leadership may require related experience to the Associate Insurance Representative at Sanford Health for internal applicants.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingrevenue cycle managementmedical documentationaccount follow-updenial resolutiontrend analysisbilling compliancedata entryinsurance verificationpatient account management
Soft skills
problem-solvingcommunicationaccuracycourtesyprofessionalismaccountabilityattention to detailcustomer serviceinterpersonal skillstime management