Insurance Representative
Marshfield Clinic Health System, Sioux Falls, SD, United States
Overview
Sanford Health
is one of the largest not-for-profit health systems in the United States. This remote position is located in Central Time (Remote, SD). Job Summary
The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement. Must understand and 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 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 department procedures to effectively submit and/or correct errors on claims. Processes and resolves denials. Uses advanced knowledge 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 and submitting claims. 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, uses the correct resources to ensure completion of the claim. Accurately follows the claim through the entire billing process and ensures compliance with regulations. Demonstrates accountability by using appropriate resources and channels to problem solve issues. Maintains data entry accuracy, professional telephone and written communications, and timely resolution of billing complaints. Documents all contacts regarding patient accounts in the computer system. Depending on location, may verify demographics, identify appropriate third-party payers, set up insurance, initiate patient financial assistance, and verify completeness and accuracy of information. Responsibilities
Prepare and submit claims to payers (electronic or paper). Secure required medical documentation requested by payers. Identify and follow up on outstanding insurance balances; take action for account resolution. Process and resolve denials; handle payer rejections with appropriate procedures. Conduct trend analyses, appeals, and resolutions of low payments or underpaid accounts. Provide input for payer-specific meetings and communicate issues delaying payments. Maintain accuracy and timeliness in billing; document all contacts and activities. Verify demographics and insurance information; set up accounts and prepare claims forms as needed. 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. For internal applicants, leadership may require related experience to the Associate Insurance Representative role. Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Benefits include health, dental, vision, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package. For more information about Total Rewards, visit the Sanford Careers benefits page. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or email talent@sanfordhealth.org. Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. Req Number:
R-0255472 Job Function:
Revenue Cycle Featured:
No
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Sanford Health
is one of the largest not-for-profit health systems in the United States. This remote position is located in Central Time (Remote, SD). Job Summary
The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement. Must understand and 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 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 department procedures to effectively submit and/or correct errors on claims. Processes and resolves denials. Uses advanced knowledge 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 and submitting claims. 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, uses the correct resources to ensure completion of the claim. Accurately follows the claim through the entire billing process and ensures compliance with regulations. Demonstrates accountability by using appropriate resources and channels to problem solve issues. Maintains data entry accuracy, professional telephone and written communications, and timely resolution of billing complaints. Documents all contacts regarding patient accounts in the computer system. Depending on location, may verify demographics, identify appropriate third-party payers, set up insurance, initiate patient financial assistance, and verify completeness and accuracy of information. Responsibilities
Prepare and submit claims to payers (electronic or paper). Secure required medical documentation requested by payers. Identify and follow up on outstanding insurance balances; take action for account resolution. Process and resolve denials; handle payer rejections with appropriate procedures. Conduct trend analyses, appeals, and resolutions of low payments or underpaid accounts. Provide input for payer-specific meetings and communicate issues delaying payments. Maintain accuracy and timeliness in billing; document all contacts and activities. Verify demographics and insurance information; set up accounts and prepare claims forms as needed. 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. For internal applicants, leadership may require related experience to the Associate Insurance Representative role. Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Benefits include health, dental, vision, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package. For more information about Total Rewards, visit the Sanford Careers benefits page. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or email talent@sanfordhealth.org. Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. Req Number:
R-0255472 Job Function:
Revenue Cycle Featured:
No
#J-18808-Ljbffr