Job Description

POSITION SUMMARY The Insurance Representative performs insurance-related functions, such as insurance follow-up, customer service, and/or pre-service estimates. The actual work performed will be dependent upon client needs, current active projects, and projects could be long-term or short-term. This position requires the ability to work independently, accomplish goals, excellent customer service and communication skills, creativity, patience, and flexibility. The Insurance Representative relies on guidelines established by the organization to perform job functions and works under general supervision in a fast-paced environment.
PRIMARY RESPONSIBILITIES

• FOR INSURANCE FOLLOW-UP
  

• Communicate with insurance companies regarding the status of a claim(s) and effectively resolve denied claim(s).
• Follow-up on claims within appropriate time frame.
• Prepare and submit appeals on insurance denials.
• Stay persistent in your disputes with insurance companies regarding denied claims.
• Track trending denials.
• Review self-pay balances that have insurance denials needing write-off. Adjustment requests are typically sent back to the client & FAC will monitor until the adjustment has posted.
• Complete insurance payment/adjustment audits on accounts.
• Take insurance information that is provided by either the consumer or insurance company and supplies that information to the client or loads the insurance into the client system and submit claims.
• Review all insurance faxes that are received and update the accounts appropriately. Faxes typically request medical records, insurance registration updates, coding review requests, etc. Many insurance faxes are received not only on self-pay balances but balances that are still pending with insurance.
• Utilize available client systems to ensure we are not providing the client with insurance information that has already been billed.
• Utilize available client systems to monitor the status of accounts after the claim has been filed to insurance.
• Utilize available client systems to check for insurance payments and adjustments.
• Serve as the first line of review for all self-pay and/or insurance balances that need an additional review on the insurance denial/dispute.
• May perform additional insurance follow-up-related tasks as needed.
• Perform other duties as assigned.

• CUSTOMER SERVICE
  

• Perform quality audits for the client on incoming and outgoing patient phone calls regarding accounts.
• Direct contact with patients regarding an escalated account.
• Investigate possible deceased patient accounts.
• Contact the patient for updated demographics.
• May perform various insurance follow-up related tasks as needed.
• Perform other duties as assigned.

• FOR PRE-SERVICE ESTIMATES

• Politely and promptly answers telephone calls.
• Correctly identify and collect patient demographic information in accordance with company and/or hospital standards.
• Schedule appointments in the centralized scheduling system, in accordance with service standards using scripted language for greeting the caller, reviewing the scheduling activity, and summarizing the transaction at the end of the call.
• Consistently adhere to high standards of customer service.
• Is proactive in preventing issues with a patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating and documenting order retrieval in notes for check-in person.
• Communicate information to the patient regarding questions about physician referrals, insurance referrals, and consultations.
• Document (when necessary) account notes in scheduling and registration systems.
• Identify and work to minimize the potential financial risk of patient accounts through financial reports, systems information, or direct contact.
• Assess and communicate coverage limitations and payment expectations with patients.
• Facilitate the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, using online tools, worklists, and direct phone calls as necessary.
• Respond to questions and concerns.
• Perform other duties as assigned.

Work Hours: Monday \xe2\x80\x93 Friday 8 am to 5 pm or 9 am to 6 pm, depending on the project assignment.
Must live within 30 miles of Campbellsville, KY.
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE

• Minimum High School diploma or equivalent required.
• 1-2 years of experience in the Insurance Industry is preferred.
• Minimum 1-2 years of experience in medical billing, insurance verification, and working insurance denials is preferred.
• Previous experience in customer service, collections, or a related role is preferred.
• Ability to work in a fast-paced environment.
• Ability to communicate clearly and briefly, utilizing proper grammar and telephone etiquette.
• Ability to compute basic math calculations using addition, subtraction, multiplication, division, and percentages.
• Knowledge of federal, state, and local laws, regulations, and rules concerning the insurance industry.
• Knowledge of healthcare and/or insurance practices required.

SKILLS & ABILITIES

• Must possess interpersonal skills to handle sensitive and confidential situations.
• Position continually requires demonstrated self-confidence, skill, and diplomacy.
• Proven ability to organize and motivate.
• Communicate clearly, concisely, and effectively both verbally and written, bilingual in Spanish is a plus.
• Must have a working knowledge of a Windows-based system; experience in word processing, email, and Excel is required.
• Some analytical ability is required to gather information from consumers, find solutions and prioritize work.
• Work requires continual attention to detail in data entry of information related to consumer interactions.
• Strong listening skills \xe2\x80\x93 Ability to listen and understand directions.
• Ability to converse and respond to common inquiries from consumers and members of the general public.
• Ability to write business-related documents such as letters, emails, and other business correspondence as needed.
• Strong individual work ethic possessing the ability to work within a team highly driven, self-starter with the ability to work independently as well as contribute to a team environment.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee frequently is required to use hands to dial a telephone, utilize a computer keyboard and mouse, and operate office equipment. The employee is occasionally required to stand, walk, and reach with hands and arms, as well as lift up to 20 pounds.
WORK ENVIRONMENT The employee works in a temperature-controlled office environment. The employee sits at a desk during regularly scheduled work hours, answers and makes telephone calls using a standard telephone, types on a standard keyboard, and reads and comprehends information from a computer terminal and/or written resources.
COMPENSATION & BENEFITS

• Market competitive compensation program.
• Health, Gym discounts, Dental, Vision, Life, Health Savings Account, Flexible Spending Account, 401(k), Paid Time Off, Paid Holidays, & More.

The company extends equal employment opportunities to qualified applicants and employees on an equal basis regardless of an individual\'s age, race, color, sex, religion, national origin, disability, veteran status, sexual orientation, gender identity, gender expression, or any other reason prohibited by law.

Education

Preferred

• High School or better

Behaviors

Preferred

• Team Player: Works well as a member of a group
• Enthusiastic: Shows intense and eager enjoyment and interest
• Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

Preferred

• Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
• Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work