Description

The position is available only for work within following states: TN and KY (must live 30 miles within Campbellsville, KY)

POSITION SUMMARY

The Insurance Representative performs insurance-related functions, such as insurance follow-up, precertification, and/or pre-service estimates, for a variety of clients. 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

Communicate with insurance companies regarding the status of a claim(s).
Prepare and submit appeals on insurance denials.
Review self-pay balances that have insurance denials needing write-offs. Adjustment requests are typically sent back to the client & FAC will monitor until the adjustment has been 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.
Perform other duties as assigned.

Work Hours: 8:00AM - 5:00PM EST, Monday – Friday

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.
Previous experience in customer service, collections, or a related role is preferred.
Knowledge of federal, state, and local laws, regulations, and rules concerning the insurance industry.
Knowledge of federal, state, and local laws, regulations, and rules concerning the insurance industry.
Knowledge of healthcare and/or insurance practices preferred.

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 a plus.
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.
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 – 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.

LANGUAGE SKILLS

Ability to converse and respond to common inquiries from senior management and all other internal customers.
Ability to write business-related documents such as letters, emails, and other business correspondence as needed.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions.

PHYSICAL DEMANDS

The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to sit, talk, see, and hear. The employee frequently is required to use their 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 and 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.

Qualifications

Behaviours

Required

Thought-provoking: Capable of making others think deeply on a subject

Team player: Works well as a member of a group

Enthusiastic: Shows intense and eager enjoyment and interest

Detail-oriented: Capable of carrying out a given task with all the details needed to get the task done well

Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivation

Required

Work-life balance: Inspired to perform well by having ample time to pursue work and interests outside of work

Self-starter: Inspired to perform without outside help

Goal completion: Inspired to perform well by the completion of tasks

Ability to make an impact: Inspired to perform well by the ability to contribute to the success of a project or the organisation

Preferred

Growth opportunities: Inspired to perform well by the chance to take on more responsibility

Education

Required

High School or better.

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