Medical Insurance Representative

Position Summary

This position reviews and completes patient registration functions needed to analyze and collect routine claims. It conducts other various reviews of non-complex collection charges, claims/bills, and payment records. It determines action to complete, correct, and process these documents based on proper billing guidelines. This position interacts with patients, guarantors, insurance companies, government representatives and other related interested parties to properly adjudicate outstanding charges and complete the revenue cycle. This position requires and understanding of billing requirements and billing regulations. The Medical Insurance Representative functions under direct supervision of the Medical Billing Management.

Duties & Responsibilities

Review, gather, and enter patient demographic and payment details into electronic health record system (E.H.R.) to ensure proper record retention. Required E.H.R. information is obtained from various sources including correspondence with patients, health care providers, insurance companies, third party documents, and payer portals. Review and analyze claims for discrepancies and determines the appropriate action to complete the billing process. This includes identifying appropriate service payer, guarantor account, or creation of account as needed based on accepted industry methods for billing medical services.

Address incoming calls to the customer support number and giving information. The calls will contain a variety of inquiries from health care providers, patients or plan members, insurance companies, government agencies and persons utilizing the services of a facility. In the event the Medical Insurance Representative cannot complete the service call, the inquiry will be forwarded to an appropriate member of the Medical Billing Office. Process correspondence, questions or requests obtained from various sources and identify proper department for resolution. This may include review of itemized charges, payment processing within E.H.R., claims/bills education with internal and external parties, or correction of personal data for accuracy and/or completeness.

Under direction, reviews, analyzes and processes the submission of claims by performing edits in E.H.R. or other vendor software. Review and accept the generation of patient statements. Upon acceptance, select E.H.R. functions to distribute to appropriate third party payer. Make inquiries daily by either phone, electronic message, or written correspondence to collect outstanding values on service performed from identified parties. Document and track patient contacts via E.H.R. system or other verifiable sources.

Produce Patient service estimates detailing Cost, deductions, and net collection values due. These estimates will be developed utilizing the E.H.R. system using current industry and regulatory requirements. Produce Medical Record requests submitted to Billing office. Medical Records will be obtained using current E.H.R. system. The submission will be completed based on industry and regulatory requirements’.

Participates in staff meetings, other educational activities, and performs other related duties as assigned

Minimum Qualifications:

Any one or any combination that equals?six (6) months?from the categories below:

1. experience within a health insurance/medical billing environment
2. medical billing certification from an accredited program (i.e., Certified Professional Coder (CPC); Registered Health Information Technician (RHIT); Certified Coding Specialist (CCS); Registered Health Information Administrator (RHIA); National Healthcareer Association (NHA))
3. college coursework in insurance/benefits administration, human resource management, health information management, finance, accounting or closely related fields such as business administration and/or business management

• 30 semester hours equals 6 months
• 60 semester hours equals 1 year (12 months)
• 90 semester hours equals 2 years (24 months)
• 120 semester hours or higher equals 3 years (36 months)