Hamilton Health Care System, Inc.
Job Description and Performance Standards
Title: Insurance Rep 339005210
Reports To: Patient Accounts Manager
Shift: 8:30am-5:00pm Monday-Friday
Status: Full Time
Works under direct supervision of the Patient Accounts Manager and follows written policies and procedures to perform the job duties. Performs basic administrative job duties relating to submitting claims and following up with third party payers for both primary and secondary claims. Responsible for reviewing and correcting all claims edits in both the Soarian Financials and the ePremis systems. Transmits accurate claims daily via the ePremis electronic claims system. Monitors all outstanding submitted claims to ensure prompt payment. Follows up with insurance carriers via websites and occasional telephone calls to obtain payment as quickly as possible. Completes required daily activity reporting, this includes but is not limited to verifying claims data, report reconciliation, account database maintenance, file maintenance, etc. Interfaces with customers/vendors, establishes and maintains positive business relationships internally and externally to ensure effective & efficient coordination of services to promote individual and departmental goals. Ensures the accuracy and timeliness of all claims submission. Provides support to team members. Works reports and worklists including denial management reports and the EBEW to correct errors or identify and resolve missing information. Must have the ability to learn, follow oral and documented instructions and/or apply general knowledge of the CBO’s department procedures, practices, standards, etc. Resolves routine questions and problems and refers more complex issues to higher levels. Performs additional duties as assigned in a courteous and professional manner.
Insurance Representatives will have 0-5 years experience in insurance claims billing and follow-up at Hamilton Medical Center.
Education: Completion of a high school diploma required. College level courses preferred.
Licensure: HFMA CPAR certification preferred.
Experience: Prefer experience in a same or similar position in a hospital or physician practice is desirable.
Skills: Excellent oral and written communication skills in order to effectively interact with internal and external customers. Job duties and tasks are frequently non-routine which requires logical problem solving ability. Ability to interpret and follow oral and written instructions, policies, guidelines and standards. Ability to use good judgment in the absence of formal guidelines, policies or procedures. Ability to prioritize and manage time effectively. Working knowledge of medical A/R software programs and intermediate PC skills including Microsoft Outlook, Word and Excel. Must be detail oriented and able to demonstrate competence in basic math concepts.
PHYSICAL, MENTAL, ENVIRONMENTAL AND WORKING CONDITIONS
Normal business office environment. Constant sitting and limited freedom of movement. High pressure environment due to large volumes and claims filing and follow up deadlines.