Insurance Claims Lead Representative- Remote

Conifer Health Solutions-posted 9 months ago
$18 - $28/Yr
Full-time • Mid Level
Remote • Frisco, TX
Ambulatory Health Care Services
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The Insurance Claims Lead Representative is responsible for providing assistance, coaching, and training to staff members, including new hires. This role supports the team, supervisor, and management with complex inventory and issue resolution. The representative is responsible for all aspects of billing, follow-up, and collection activity for payers that are Supplemental to Medicare. They may maintain a large dollar inventory desk or complex accounts and serve as just-in-time staffing, working inventory for team members that may be absent or backlogged. Additionally, they may assist in special projects assigned by management, acting as a point of contact for internal operational questions.

  • Responsible for all aspects of insurance follow-up and collections, including making telephone calls and accessing payer websites.
  • Maintain a large dollar inventory desk and serve as just-in-time staffing for team members that may be absent or backlogged.
  • Effectively resolve complex or aged inventory, including payment research and payment recoups with minimal or no assistance.
  • Accurately document the pertinent collection activity performed.
  • Review account information and necessary system applications to determine the next appropriate work activity.
  • Verify claims adjudication utilizing appropriate resources and applications.
  • Initiate contact with patients to obtain additional information as needed.
  • Perform appropriate billing functions, including manual re-bills and electronic submission to payers.
  • Edit claims to meet billing compliance guidelines for electronic submission.
  • Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.
  • Proactively identify issues or trends and provide suggestions for resolution.
  • Provide assistance, coaching, and training to staff members, including new hires.
  • Participate in the new hire peer interviewing process.
  • Assist in special projects assigned by management.
  • Participate in meetings, training seminars, and in-services to develop job knowledge.
  • Respond timely to emails and telephone messages from staff, management, and clients.
  • Effectively communicate issues to management and develop solutions.
  • High school diploma or equivalent education.
  • 3-6 years experience in Medical/Hospital Insurance related collections.
  • Very good written and verbal communication skills.
  • Strong interpersonal skills.
  • Advanced technical skills including PC and MS Outlook.
  • Advanced knowledge of UB-04 and Explanation of Benefits (EOB) interpretation.
  • Advanced knowledge of CPT and ICD-9 codes.
  • Advanced knowledge of insurance billing, collections, and insurance terminology.
  • Medical, dental, vision, disability, and life insurance.
  • Paid time off (vacation & sick leave) - minimum of 12 days per year, accruing at a rate of approximately 1.84 hours per 40 hours worked.
  • 401k with up to 6% employer match.
  • 10 paid holidays per year.
  • Health savings accounts, healthcare & dependent flexible spending accounts.
  • Employee Assistance program, Employee discount program.
  • Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
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