Insurance Representative at Sanford Health

, Michigan, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Jul, 26

Salary

25.5

Posted On

04 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims processing, Revenue cycle management, Medical documentation, Account reconciliation, Denial management, Data entry, Billing compliance, Trend analysis, Appeals processing, Customer service, Computer literacy, Software application proficiency, Communication skills, Problem solving, Insurance verification

Industry

Hospitals and Health Care

Description

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re 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 healing across 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 We are seeking a team member who is eager to learn and develop new skills. The position work schedule is Monday - Friday with flexibility in work start and stop times. Summary The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement. Job Description 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. 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. Consistently demonstrates ability to input data accurately into the computer system. Consistently answers the telephone courteously. Maintains and updates computer skills as needed for work assignments. Demonstrates the ability to utilize software applications for maximum efficiency. Consistently ensures verbal communication is courteous, complete, and professional whether using phone or personal contact. Consistently ensures written communication is accurate, complete and professional in presentation whether word processing or using email. Identifies and promptly resolves billing complaints. Directs issues to supervisor when unable to resolve. Documents in computer system all contacts regarding patient accounts. Depending on location, may verify demographics, identify appropriate third-party insurance/payers, set up insurance, initiate patient financial assistance. Contact the insured or financially responsible party to obtain missing information. Verify, create or update patient accounts for billing, prepare insurance claims forms or related documents, and verify completeness and accuracy. 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. 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. The Sanford organization owns and manages multiple distinct brands, including Sanford Health, Marshfield Clinic, and Good Samaritan, as well as Lewis Drug, Sanford Health Equip, Solutions by Sanford, Great Shots, and Blue Rock Bar & Grill. Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization has 53,000 employees and serves over 2 million patients and nearly 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 56 hospitals, 288 clinic locations, 147 senior care communities, 4,000 physicians and advanced practice providers and nearly 1,500 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to 78 specialties. Learn more about Sanford Health’s commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News. Good Samaritan, one of the nation’s largest nonprofit providers of senior care and services, is committed to transforming the aging experience through innovation, compassion and personalized care. As part of Sanford Health, an integrated nonprofit health system headquartered in Sioux Falls, South Dakota, Good Samaritan serves 10,000 seniors and offers access to a full continuum of care, including 94 rehabilitation and skilled nursing centers, 56 assisted living and memory care facilities, 44 independent living locations and 37 home health and hospice agencies. The senior care provider delivers services across the upper Midwest, with 70% of residents living in rural communities. Learn more about Good Samaritan’s mission and commitment to delivering high quality senior care in rural America at good-sam.com.

Responsibilities

The Insurance Representative processes and monitors unpaid third-party insurance and government-assisted program accounts to ensure proper reimbursement. They are responsible for preparing and submitting claims, resolving denials, and performing account follow-ups in accordance with federal and state regulations.