Insurance Services Representative

About the role

The Insurance Services Representative ensures the timely and accurate processing, submission, follow-up and resolution of healthcare insurance claims. The role reviews claims for accuracy, monitors aged accounts, investigates denials and works with internal departments and insurance carriers to secure prompt reimbursement. It also supports customer service around billing inquiries, payment posting and denial resolution.

Key responsibilities

• Scrub insurance claims for errors and coordinate corrections with the relevant departments.
• Process account reconciliation and submit claims accurately and within required timelines.
• Monitor claims data in the computer system for accuracy and completeness.
• Follow up on unpaid or aged claims over 30 days from submission.
• Log, track, review and investigate denials, and challenge them where appropriate.
• Ensure explanations of benefits (EOBs) needing action are addressed and forwarded to responsible parties.
• Prepare monthly aged receivables reports for carriers and management, and prepare and distribute Balance After Insurance (BAI) statements to patients.
• Enter claims and payments correctly, post payments, adjustments and discounts to the right accounts, and keep organized filing systems.
• Build positive relationships with insurance carriers and respond to patient and customer inquiries about claims, billing and reimbursement disputes.
• Take part in performance improvement and revenue cycle initiatives, assist with billing complaint investigations, and perform quality checks on claims.
• Attend departmental meetings and training, cross-train in other areas, and perform other duties as assigned.

Required profile

• Certified Professional Coder (CPC) credential from the AAPC, current and in good standing.
• Bachelor's degree in Healthcare Administration, Business Administration or equivalent.
• Experience in healthcare claims processing, preferably in an insurance services environment.
• Proven ability to prioritize tasks and meet deadlines in a fast-paced environment.

Required skills

• Knowledge of ICD-10, CPT, HCPCS, Revenue Codes and medical terminology.
• Familiarity with medical billing systems is preferred.
• Strong organization, attention to detail, problem-solving and confidentiality.