Job Details

Overview

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. Were proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healingacross our broad footprint.

Work Shift: 8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours: 40

Salary Range: $16.00 - $25.50

Union Position: No

Department Details

Summary

The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement.

Responsibilities

• Understand and be able to work accounts throughout the entire revenue cycle.
• Prepare and submit claims to payers electronically or by paper.
• Secure necessary medical documentation required or requested by payers.
• Proactively identify and perform account follow-up on outstanding insurance balances and take necessary action for account resolution in accordance with established federal and state regulations.
• Complete work within authorized time to assure compliance with departmental standards.
• Keep updated on all state/federal billing requirements and changes for insurance types within area of responsibility.
• Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims.
• Process and resolve denials; use advanced knowledge to process payer rejections.
• Conduct trend analyses, appeals and resolve low payment or underpaid accounts.
• Provide input for payer-specific meetings.
• Handle difficult account situations and resolve issues delaying or preventing payments from payers.
• Perform miscellaneous job-related duties as requested.
• Demonstrate accuracy in correcting (identified through pre-edits) and submitting claims; ensure accounts are billed in a timely manner.
• Escalate to a manager any accounts that cannot be finished in a timely manner.
• When claims are disputed, utilize the correct resources to ensure completion of the claim.
• Accurately and completely follow the claim through the entire billing process.
• Ensure all claims consistently meet compliance regulations.
• Demonstrate accountability by using appropriate resources and channels to problem-solve issues.
• Input data accurately into the computer system and maintain courteous communication by phone or in person.
• Maintain and update computer skills as needed; utilize software applications for maximum efficiency.
• Ensure written communication is accurate, complete, and professional in presentation.
• Identify and promptly resolve billing complaints and direct issues to the supervisor when unable to resolve.
• Document in the computer system all contacts regarding patient accounts.
• Where applicable, verify demographics, identify appropriate third-party payers, set up insurance, initiate patient financial assistance, obtain missing information, verify/create/update patient accounts for billing, and prepare insurance claims forms or related documents.

Qualifications

• High school diploma or equivalent preferred; post-secondary or trade courses in accounting, business, and communications are helpful.
• Six months of related work experience required.
• Computer skills essential.
• When applicable and if desired, leadership may require related experience to the Associate Insurance Representative for internal applicants.

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-###-#### or send an email to ...@sanfordhealth.org.