Lead Insurance Representative

Insurance Representative Lead

Position Title: Insurance Representative Lead Full Time Day Shift Compensation: $24.04 - $32.69 HR The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and comparisons to colleagues in similar roles.

Saint Anthony Hospital is a diverse and community-centric organization your career can thrive in, while addressing the health and wellness challenges that families in our neighborhood face. Our employees deliver on our mission and achieve success by working together to provide excellent customer service.

Position Purpose

The Lead Insurance Representative performs billing, follow-up and collection activities on patient accounts receivable owed to Saint Anthony Hospital for services rendered while maintaining daily and weekly productivity standards established within the Patient Financial Services department for this position. Responsible for initiating automated claims processing activities using claims editing software for all claims in an efficient, accurate and time-conscious manner.

Essential Functions (list in order of importance including measures)

1. Collects all outstanding accounts receivable balances due to SAH within the workload assigned while complying with all applicable collection laws and regulations. Contact third party payers by telephone or electronically to resolve unpaid balances due by the payers.
2. Effectively utilizes collector workstation and other system functionality to prioritize, allocate, and report work. Completes daily and weekly management and productivity reports as required. Documents activities as appropriate in the collection notes and workstation of the system.
3. Works denials ($0 payment) from third party payers (via voucher, correspondence, or electronic posting) to correct and re-bill all claims prior to claim filing deadlines. Accounts that cannot be re-billed should be appealed according to the payers' guidelines. Reviews and resolves correspondence related to the assigned workload to obtain payment.
4. Reviews high-dollar and complex accounts and escalate as appropriate.
5. Supports staff development through training on payer rules, workflows, and system updates.
6. Provides flexible coverage across teams as needed.

Marginal Functions (list in order of importance)

• Performs both essential and marginal job functions in a safe manner as identified by Saint Anthony Hospital and the respective department while adhering to the Hospital's confidentiality norms and standards. Actively and consistently demonstrates the core values of Saint Anthony Hospital in all interactions with others.
• Assumes responsibility for knowing and maintaining established hospital and departmental objectives, policies/procedures including general sanitation, safety, environmental and infection control standards.
• Participates in performance activities including problem identification, data collection, solution selection, implementation and evaluation. Also, assists in the care and maintenance of departmental equipment and supplies as appropriate.
• Participates in staff meetings and other services, meetings or committees as required.

General Job Requirements

• Knowledge of CMS, Medicaid, Managed Care, and Commercial billing and collection laws, guidelines, and regulations.
• Ability to read and understand provider contracts.
• Knowledge of system support issues that affect billing, collection, and cash application functions.
• Previous billing experience preferred.

Benefits:

• Comprehensive Health Insurance Plans (Medical, Dental, Vision) **Coverage begins on new hires on the first day**
• Employer matching retirement plans
• Eligibility for the Public Service Loan Forgiveness (PSLF) Program
• Free parking
• Basic & Supplemental Life Insurance/Accidental Death & Dismemberment Insurance
• Paid Time Off & Holidays

Saint Anthony Hospital Highlights:

• Community Hospital with Modern Technology: Work in an environment that blends advanced tools with a mission?driven, community?focused approach.
• Competitive Salaries: Earn a strong, market?aligned compensation package.
• Innovative Environment: Be part of a soon?to?come transformation as we transition into a new, next?generation healthcare campus.
• Collaborative Culture: Join a close?knit team that values communication, teamwork, and mutual support.
• Professional Growth: Build your skills in an organization that invests in its people and encourages continuous development.
• Meaningful Work: Serve a diverse patient population and make a real impact on their health journey.
• Recognition: We are a certified Primary Stroke Center and a respected teaching hospital shaping the next generation of healthcare professionals.