Senior Insurance Rep

PFS Group•Houston, TX

10d•Onsite

About The Position

Under the supervision of the Insurance Supervisor, the Senior Insurance Representative ensures the efficient operation and effective reimbursement of hospital or professional insurance claims by leading efforts on researching unpaid balances, correcting billing errors, writing and filing appeals, and submitting any other requirement to secure payment. The Senior Rep acts as a technical expert in insurance follow-up workflows, assisting the Supervisor by working special projects and training teammates on core job functionals. The Senior Rep will assist with SOPs and creation of other references on behalf of their team, and will be the key contact for complex or escalated accounts.

Requirements

Ability to research and train others on payer billing policies and medical bulletins to accurately troubleshoot denials and unpaid balances
Expert knowledge in all aspects of insurance reimbursement
Capable of learning and training on multiple software systems
Proficiency in Microsoft Office suite
Ability to work well under pressure and multi-task routinely
Professional acumen and interpersonal skills
Demonstrated stable work history
HIPAA knowledge and compliance
At least three years experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash Posting
A combination of education and experience may be used
High school diploma or equivalent required

Nice To Haves

Experience with Epic HB Resolute PFS

Responsibilities

Initiates contact with insurance payers to collect contracted rates on outstanding claims
Takes ownership of cash collection opportunities and team performance on behalf of their assigned client
Trains new hires on critical job functions
Successfully identifies root causes for denials or non-payment, prioritizing collection metrics in all work efforts
Ensures timely filing deadlines are achieved according to payer guidelines
Monitors accounts for updates on claims processing, taking care to resolve balances with single interventions whenever possible
Request appropriate claim corrections and rebill as needed
Reviews escalated accounts and updates supervisor of trends identified
Interprets payment variances and payer guidelines to monitor for underpayment opportunities; creates SOPs to help team with these functions
Corrects adjustments as needed to ensure balances are accurately documented
Displays proficiency with assigned payer policies and updated guidelines
Posting of all pre-determined adjustments within the hospital system (non-Houston offices)
Trains on team, client, and payer protocols needed to secure payment
Complies with all federal, state, managed care, and client compliance requirements
Meets all department performance requirements, to include productivity, quality, and attendance standards
Performs other duties as requested in a team-oriented environment