Medical Insurance Supervisor Jobs (NOW HIRING)

JOB SUMMARY 

Under the supervision of the Insurance Supervisor, the Senior Insurance Representative ensures the efficient operation and effective reimbursement of hospital or professional insurance claims by leading efforts on researching unpaid balances, correcting billing errors, writing and filing appeals, and submitting any other requirement to secure payment. The Senior Rep acts as a technical expert in insurance follow-up workflows, assisting the Supervisor by working special projects and training teammates on core job functionals. The Senior Rep will assist with SOPs and creation of other references on behalf of their team, and will be the key contact for complex or escalated accounts. 

ESSENTIAL FUNCTIONS

1. Initiates contact with insurance payers to collect contracted rates on outstanding claims
2. Takes ownership of cash collection opportunities and team performance on behalf of their assigned client
3. Trains new hires on critical job functions
4. Successfully identifies root causes for denials or non-payment, prioritizing collection metrics in all work efforts
5. Ensures timely filing deadlines are achieved according to payer guidelines
6. Monitors accounts for updates on claims processing, taking care to resolve balances with single interventions whenever possible
7. Request appropriate claim corrections and rebill as needed
8. Reviews escalated accounts and updates supervisor of trends identified
9. Interprets payment variances and payer guidelines to monitor for underpayment opportunities; creates SOPs to help team with these functions
10. Corrects adjustments as needed to ensure balances are accurately documented
11. Displays proficiency with assigned payer policies and updated guidelines
12. Posting of all pre-determined adjustments within the hospital system (non-Houston offices)
13. Trains on team, client, and payer protocols needed to secure payment
14. Complies with all federal, state, managed care, and client compliance requirements
15. Meets all department performance requirements, to include productivity, quality, and attendance standards
16. Performs other duties as requested in a team-oriented environment

KNOWLEDGE, SKILLS, AND ABILITIES

1. Ability to research and train others on payer billing policies and medical bulletins to accurately troubleshoot denials and unpaid balances
2. Expert knowledge in all aspects of insurance reimbursement
3. Capable of learning and training on multiple software systems
4. Proficiency in Microsoft Office suite
5. Ability to work well under pressure and multi-task routinely 
6. Professional acumen and interpersonal skills
7. Demonstrated stable work history 
8. HIPAA knowledge and compliance

EDUCATION AND EXPERIENCE

1. At least three years experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash Posting
2. A combination of education and experience may be used
3. High school diploma or equivalent required 

Preferences

1. Experience with Epic HB Resolute

PFS Group

Nationwide Patient Account Management Firm.

Based in Houston, Texas, we currently work with 32+ clients who operate more than 100 hospital facilities from small, rural community medical centers to metro population center health systems. Leaders in their respective markets and nationwide, our clients rely on our services to support their accounts receivable departments.

PFS Group offers a friendly, caring work environment, with competitive benefits and compensation, (medical, dental, vision, short and long-term disability, life insurance, hospital indemnity, critical illness, accident insurance and a matching 401(k) and Zayzoon!

If you are looking for a position in a dynamic, fast-paced organization with career growth opportunities, come grow with us! www.pfsgroup.org