Insurance and Claims Representative-Lead

Job Posting: Insurance and Claims Representative -Lead

Location: Cherry County Clinic, Valentine Ne 69201

Benefit Eligible: Yes

Position Summary:
We are seeking a detail-oriented and organized Insurance and Claims Representative to join our team at the Cherry County Clinic. In this role, you will perform a variety of clerical and patient accounting functions within the patient accounting, accounts receivable, or hospital revenue cycle areas. The role involves handling insurance claims, billing processes, and ensuring compliance with all regulatory requirements. The position offers a great opportunity for those with prior medical billing or insurance experience, and it includes the potential to act as a Lead Representative in the future.

Duties and Responsibilities:

• Work with daily electronic billing files and submit insurance claims to all payer types, including Medicare, Medicaid, Managed Care, HMO, PPO, and patient.
• Accurately bill patient accounts to ensure timely claim submission and reimbursement from all payer types.
• Review, evaluate, and forward manual patient account statements to payers that require special handling.
• Document all billing activity on patient accounts and ensure compliance with billing regulations.
• Review claims for accuracy and collaborate with other departments to provide necessary information for audits and record reviews.
• Make corrections based on payer error reports to optimize electronic claim submissions.
• Respond to written or oral requests for itemized bills from patients, insurance companies, and attorneys.
• Ensure proper billing and reimbursement for all services and supplies provided to patients.
• Perform other reporting tasks related to revenue cycle functionality as needed.
• Maintain patient confidentiality in accordance with HIPAA and organizational policies.
• Comply with Corporate Compliance and hospital personnel policies.
• Perform other duties as assigned by the supervisor.

When Acting as a Lead:

• Oversee day-to-day department operations.
• Work closely with payer representatives to ensure clean claims and reimbursement.
• Stay current with changes in payer policies, including Medicare, Medicaid, Managed Care, HMO, and PPO.
• Manage electronic enrollment processes, including claims, EFT, and remittance advice.
• Handle provider enrollment with various payers.
• Coordinate with state claim reporting bureaus.
• Delegate tasks, set deadlines, and provide feedback to the team.
• Lead recruitment, selection, and training of team members.
• Provide coaching and support to team members and foster a positive team environment.
• Resolve conflicts and escalate issues as necessary.
• Serve as a role model and contribute to department and organizational change.

Skills and Abilities Required:

• Ability to operate business machines, including computers, telephones, and office equipment.
• Strong verbal communication skills, with the ability to interact effectively with various individuals.
• Ability to read fine print on documents and access files for accurate handling of accounts.
• Proficient in general office duties and customer service tasks.
• Capable of maintaining confidentiality of patient and hospital information.
• Strong understanding of state and federal confidentiality laws, including HIPAA.
• Ability to sit, stand, and walk variable distances as required by the job.
• When acting as a Lead, strong communication, problem-solving, time management, and coaching skills are essential.

Physical Demands and Working Conditions:

• Work in a well-lighted and ventilated office environment with frequent interruptions.
• Requires exertion of negligible to 50 pounds of force periodically to move objects.
• Ability to perform tasks involving sitting, talking, repetitive motion, and listening.
• Requires manual dexterity to operate office machines and meet performance standards.
• Requires auditory ability to communicate via telephone and hear normal conversations in an office setting.

Comprehensive Benefit Package, which includes:

• Health Insurance: Co-pay or HSA plan options with 100% coverage for the Employee
• Dental Coverage: 100% coverage for the Employee
• Vision Coverage: 100% coverage for the Employee
• $50,000 Group Life Insurance with AD&D
• Long-Term Disability Coverage: 100% coverage for the Employee
• Medical and Dependent Care Flexible Spending Accounts
• Health Savings Account with employer contribution
• Supplemental Insurances: Short-Term Disability, Supplemental Life and AD&D, Critical Illness, Hospital Indemnity, and Accident
• Retirement Plan: 457 plan with Pre-Tax and Roth options

Reports to: Controller

Direct Reports: This position has no direct reports.

How to Apply:
If you are passionate about healthcare administration and have the required skills and experience, we encourage you to apply for this position. Join our team and contribute to the success of Cherry County Clinic!

Minimum Job Requirements:

• High School diploma required.
• 1-3 years of customer service and/or business office experience, preferably in a medical setting.
• Proficiency in Microsoft Excel, Word, and Windows.
• Knowledge of collection laws, third-party reimbursement, and basic hospital accounting.