Insurance Rep

Job Purpose:

The Insurance Representative at PFS Group under the supervision of the Insurance Supervisor, the Insurance Representative manages insurance claims to ensure timely and accurate reimbursement. The role involves researching unpaid balances, correcting billing issues, submitting appeals, and communicating with insurers, patients, and internal teams to resolve discrepancies. Strong knowledge of insurance guidelines, billing systems, and effective accounts receivable management is essential, with responsibility for managing assigned inventories based on client needs.

Key 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

Education and Experience:

• High school diploma or equivalent is required
• At lease one year experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash Posting
• Experience with EPIC HB or PB Resolute

Required Skills and Abilities:

• 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

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