Associate Insurance Representative
Sanford Health
Summary
The Associate Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement; primarily but not limited to prebilled accounts.
Job description
Summary
The Associate Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement; primarily but not limited to prebilled accounts.
Job Description
- Prepares and submits claims to payers either electronically or by paper.
- Secures necessary medical documentation required or requested by payers.
- Performs account follow-up on outstanding insurance balances and takes the necessary action for account resolution in accordance with established federal and state regulations.
- Processes daily workflow changes that depending on department may include, eligibility verification, verification of information, payment postings, initiating refunds, processing month end, resolving and troubleshooting incidents, reporting, initial billings and re-billings of claims, scanning and indexing of documents, and be the point of contact to provide assistance as needed.
- Responsible for assuring accounts are set up correctly with the information available is completed timely and accurately.
- 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 that are technical in nature (i.e.: records required denials).
- Performs miscellaneous job related duties as requested.
Requirements
- High school diploma or equivalent preferred
- Previous billing experience preferred
Company overview
Sanford Health is one of the largest integrated healthcare delivery systems in the United States, operating as a nonprofit organization headquartered in Sioux Falls, South Dakota. Founded in 1894, the organization has grown into a comprehensive health system with 44 medical centers, 482 clinics, and more than 200 senior living facilities across 26 states and nine countries. Sanford Health provides a full spectrum of healthcare services including acute care hospitals, specialty clinics, senior care through the Good Samaritan Society, genomic medicine, global clinics, and the Sanford Health Plan insurance program. The system employs over 48,000 healthcare professionals including 1,400 physicians and delivers care through five Centers of Excellence: Cancer, Children's, Heart, Orthopedics/Sports Medicine, and Women's Health. Annually, Sanford Health handles approximately 5.3 million outpatient visits, 84,000 admissions, and 136,000 surgeries. The organization is also actively involved in medical research and education through partnerships with academic institutions, positioning itself as a regional healthcare leader in the Midwest with expanding international presence.