Senior Insurance Rep

JOB SUMMARYUnder 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 FUNCTIONSInitiates contact with insurance payers to collect contracted rates on outstanding claimsTakes ownership of cash collection opportunities and team performance on behalf of their assigned clientTrains new hires on critical job functionsSuccessfully identifies root causes for denials or non-payment, prioritizing collection metrics in all work effortsEnsures timely filing deadlines are achieved according to payer guidelinesMonitors accounts for updates on claims processing, taking care to resolve balances with single interventions whenever possibleRequest appropriate claim corrections and rebill as neededReviews escalated accounts and updates supervisor of trends identifiedInterprets payment variances and payer guidelines to monitor for underpayment opportunities; creates SOPs to help team with these functionsCorrects adjustments as needed to ensure balances are accurately documentedDisplays proficiency with assigned payer policies and updated guidelinesPosting of all pre-determined adjustments within the hospital system (non-Houston offices)Trains on team, client, and payer protocols needed to secure paymentComplies with all federal, state, managed care, and client compliance requirementsMeets all department performance requirements, to include productivity, quality, and attendance standardsPerforms other duties as requested in a team-oriented environmentKNOWLEDGE, SKILLS, AND ABILITIESAbility to research and train others on payer billing policies and medical bulletins to accurately troubleshoot denials and unpaid balancesExpert knowledge in all aspects of insurance reimbursementCapable of learning and training on multiple software systemsProficiency in Microsoft Office suiteAbility to work well under pressure and multi-task routinelyProfessional acumen and interpersonal skillsDemonstrated stable work historyHIPAA knowledge and complianceEDUCATION AND EXPERIENCEAt least three years experience in revenue cycle, with emphasis on Insurance Follow-Up, Denials, Billing, or Cash PostingA combination of education and experience may be usedHigh school diploma or equivalent requiredPreferencesExperience with Epic HB ResolutePFS GroupNationwide 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! #J-18808-Ljbffr