Insurance Representative
Marshfield Clinic Health System, Lansing, MI, United States
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 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.
Responsibilities
Consistently demonstrates accuracy in correcting (identified through pre-edits) and submitting claims to payers.
Ensures accounts are billed in 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.
Maintains and inputs data accurately into the computer system and updates computer skills as needed for work assignments.
Maintains courteous telephone and written communications; resolves billing complaints; directs issues to supervisor when unable to resolve.
Documents in the computer system all contacts regarding patient accounts.
Depending on location, verifies demographics, identifies appropriate third-party payers, sets up insurance, initiates patient financial assistance; obtains missing information; verifies completeness and accuracy of patient accounts and related documents.
Qualifications
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.
Benefits Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
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 send an email to 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
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.
Responsibilities
Consistently demonstrates accuracy in correcting (identified through pre-edits) and submitting claims to payers.
Ensures accounts are billed in 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.
Maintains and inputs data accurately into the computer system and updates computer skills as needed for work assignments.
Maintains courteous telephone and written communications; resolves billing complaints; directs issues to supervisor when unable to resolve.
Documents in the computer system all contacts regarding patient accounts.
Depending on location, verifies demographics, identifies appropriate third-party payers, sets up insurance, initiates patient financial assistance; obtains missing information; verifies completeness and accuracy of patient accounts and related documents.
Qualifications
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.
Benefits Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
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 send an email to 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