[Hiring] Insurance Services Rep @Franciscan Medical Group

Role Description

As an Insurance Services Representative, you will provide essential support and expert guidance to clients regarding their insurance coverage, ensuring clear understanding and seamless service. Every day you will:

• Expertly process inquiries and explain policy details.
• Assist with claims submission and meticulously update account information.
• Demonstrate outstanding communication skills and strong problem-solving abilities.
• Contribute to client satisfaction and retention with a patient, customer-focused demeanor.

Key responsibilities include:

• Researching, reviewing, and resolving rejected, denied, underpaid, or incorrectly paid claims by analyzing account details, insurance EOBs, denial reason codes, payer requirements, and reimbursement policies to maximize appropriate revenue recovery within established timelines.
• Utilizing work queues, payer portals, spreadsheets, and practice management systems to prioritize accounts, determine next steps, organize denials by payer/type, resubmit claims electronically or via hardcopy, and enter appropriate billing corrections to ensure accurate reimbursement.
• Contacting insurance companies, payers, clinics, and other stakeholders to obtain necessary information, reopen claims when appropriate, resolve payment discrepancies within scope, and expedite prompt and accurate claim payment resolution.
• Documenting all account activity, claim history, corrections, communications, and follow-up actions accurately and thoroughly within Epic and billing systems while maintaining compliance, confidentiality, and integrity of medical records and account documentation.
• Maintaining current knowledge of billing regulations, reimbursement methodologies, government and commercial payer policies, denial management practices, payment adjustment codes, and departmental procedures to ensure quality, accuracy, and compliance standards are consistently met.
• Establishing and maintaining collaborative and professional relationships with revenue cycle teams, clinics, FMG staff, payers, and other stakeholders while effectively communicating denial, underpayment, and outstanding balance issues and escalating complex accounts appropriately when additional assistance is needed.

Requirements

• One year of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.
• Post-high school education in a field (e.g. medical billing) that would demonstrate attainment of the requisite job knowledge/abilities may be substituted, on a month-for-month basis, for the experience requirement, upon hire.