Job Details

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. Were proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Overview

The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement. Requires understanding of and ability to work accounts throughout the entire revenue cycle.

Responsibilities

• Prepare and submit claims to payers electronically or by paper.
• Secure necessary medical documentation required or requested by payers.
• Proactively identify and perform account follow-up on outstanding insurance balances and take action for account resolution in accordance with federal and state regulations.
• Comply with departmental standards and complete work within authorized time.
• Stay updated on state/federal billing requirements and changes for insurance types within area of responsibility.
• Understand edits and department procedures to effectively submit and/or correct errors on claims.
• Process and resolve denials; use advanced knowledge to process payer rejections.
• Conduct trend analyses, appeals and resolve low payment or underpaid accounts.
• Provide input for payer-specific meetings and handle difficult account situations delaying or preventing payments from payers.
• Perform miscellaneous job-related duties as requested.
• Maintain accuracy in correcting and submitting claims; ensure timely billing and escalate unfinished accounts to a supervisor as needed.
• Utilize correct resources when disputes arise to ensure claim completion; follow the entire claim through the billing process and ensure compliance.
• Demonstrate accountability by using appropriate resources and channels to solve issues.
• Input data accurately, maintain computer skills, and use software applications efficiently.
• Ensure courteous verbal and written communication in all interactions; document all contacts regarding patient accounts.
• Verify demographics, identify appropriate third-party payers, set up insurance, initiate patient financial assistance as required; obtain missing information when needed.

Depending on location, verify demographics, identify appropriate third-party insurance/payers, set up insurance, initiate patient financial assistance. Contact the insured or financially responsible party to obtain missing information. Verify, create or update patient accounts for billing, prepare insurance claims forms or related documents, and verify completeness and accuracy.

Qualifications

• High school diploma or equivalent preferred; post-secondary or trade courses in accounting, business, and communications are helpful.
• Six months of related work experience required. Computer skills essential.
• When applicable and if desired, leadership may require related experience for internal applicants.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-###-#### or send an email to ...@sanfordhealth.org.