Remote Insurance Rep

Summary

PFS Group is a patient account management firm serving hospital and health system clients. The Insurance Representative manages insurance claims and accounts receivable activities to secure timely and accurate reimbursement, including researching unpaid balances, correcting billing issues, submitting appeals, and resolving discrepancies with insurers, patients, and internal teams.

Responsibilities

• Initiates contact with insurance payers to collect contracted rates on outstanding claims
• Reviews, monitors and effectively reduces aged inventory
• Successfully identifies root causes for denials or non-payment, prioritizing collection metrics in all work efforts
• Ensures timely filing deadlines are achieved according to payer guidelines
• Monitors accounts for updates on claims processing, taking care to resolve balances with single interventions whenever possible
• Request appropriate claim corrections and rebill as needed
• Informs supervisor of trends noticed when working insurance inventory
• Interpret payment variances and payer guidelines to monitor for underpayment opportunities
• Contacts guarantors as needed to resolve coverage discrepancies
• Corrects adjustments as needed to ensure balances are accurately documented

Skills

• High school diploma or equivalent is required
• At least one year experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash Posting
• Experience with EPIC HB or PB Resolute
• Strong understanding of insurance policies, coverage, claims processes, and reimbursement, with the ability to research payer billing policies and medical bulletins to accurately troubleshoot denials and unpaid balances
• Excellent communication skills, both verbal and written, with the ability to explain complex information clearly
• Proficient in using insurance-related software and Microsoft Office Suite, including Word, Excel, and Outlook
• Strong analytical and problem-solving skills, with attention to detail
• Ability to work independently and manage time effectively in a fast-paced environment

Qualifications

Must Haves

• High school diploma or equivalent is required
• At least one year experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash Posting
• Experience with EPIC HB or PB Resolute
• Strong understanding of insurance policies, coverage, claims processes, and reimbursement, with the ability to research payer billing policies and medical bulletins to accurately troubleshoot denials and unpaid balances
• Excellent communication skills, both verbal and written, with the ability to explain complex information clearly
• Proficient in using insurance-related software and Microsoft Office Suite, including Word, Excel, and Outlook
• Strong analytical and problem-solving skills, with attention to detail
• Ability to work independently and manage time effectively in a fast-paced environment

Benefits

• Fully remote work arrangement
• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability insurance
• Long-term disability insurance
• Life insurance
• Hospital indemnity insurance
• Critical illness insurance
• Accident insurance
• Matching 401(k)
• Zayzoon