Insurance Account Representative

Insurance Account Representative# Insurance Account RepresentativeBillings, MT 59101## OverviewSalary Range$19.27 - $26.98 HourlyLevelEntryPosition TypeFull TimeJob ShiftDayEducation LevelNoneTravel PercentageNoneCategoryHealth Care## Full-Time Insurance Account Representative# **Position Title: Insurance Account Representative****Supervisor: Patient Account Manager****Supervises: None****Who We Are**We are dedicated to delivering convenient, cost-effective, and high-quality surgical and pain procedure care. Every team member plays a vital role in creating a safe, compassionate, and efficient environment for our patients.**Core Values**Confidentiality • Quality • Teamwork • Trust • Respect**Position Overview**The Insurance Account Representative plays a vital role in supporting the financial and insurance operations of the Surgery Center through insurance verification, pre-authorizations, billing, referral review, claims follow-up, and patient communication. This position works closely with patients, physicians’ offices, insurance companies, and internal departments to ensure accurate insurance processing, timely reimbursement, and positive patient financial experiences.**Duties and Responsibilities:**Insurance Verification & Authorization* Review Pain Referrals to ensure all required documentation and information are complete* Contact referring provider offices and patients regarding missing referral documentation* Obtain Workers’ Compensation and VA authorizations for Pain Referrals* Verify patient insurance eligibility, benefits, and demographic information before admission for pain and surgical cases* Obtain pre-authorizations and pre-determinations for pain procedures* Ensure physician offices have obtained required authorizations for surgical procedures* Follow up on denied or pending insurance authorizations and communicate updates appropriatelyBilling, Claims & Insurance Follow-Up* Process initial and secondary insurance billing promptly after charges are posted* Actively follow up on outstanding insurance claims to ensure timely reimbursement according to payer contracts* Prepare monthly adjustment and insurance refund reports for review and approval* Review reimbursement versus procedural costs with the Patient Account Manager to support financial viability* Verify legal ID, employer, guarantor, and insurance cards scanned during patient check-in for accuracyPatient Communication & Financial Counseling* Contact patients regarding out-of-network coverage, limited benefit plans, denied authorizations, and payment options* Discuss required copayments and patient financial responsibilities before procedures* Respond to patient and insurance company inquiries regarding billing, deductibles, copayments, coinsurance, and coverage concerns* Ensure patients complete and sign the required financial and authorization documentation when necessaryDocumentation & Administrative Support* Ensure all appropriate documentation is entered into the electronic operating system for future reference* Assist with updates to business office manuals and procedures* Maintain accurate account documentation and follow-up recordsTeamwork & Collaboration* Work closely with the Coders, Patient Access Specialists, physicians’ offices, and business office staff to support workflow efficiency* Participate in center meetings, educational opportunities, and continuing education activities* Support a positive, collaborative, and team-oriented work environmentQuality, Compliance & Confidentiality* Adhere to all company policies and procedures* Participate in the Surgery Center’s Quality Improvement Program activities, including identifying opportunities for efficiency and cost reduction* Maintain patient confidentiality at all times* Perform efficiently and appropriately during emergenciesOrganization, Flexibility & Additional Responsibilities* Prioritize responsibilities to support efficient operations and quality patient care* Demonstrate flexibility to meet the operational needs of the Surgery Center* Perform other duties as assigned**Physical Requirements:**While performing the duties of this job, the employee is regularly required to stand; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is frequently required to walk. The employee is occasionally required to sit, climb, balance, stoop, or crawl. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus.* Normal hospital environment with exposure to chemical odors, cleaning solvents, and other hazardous materials* Exposure to possible injury when working with electrical equipment and lasers, which requires care and following proper safety proceduresMedium Lifting 50 lbs maximum with frequent lifting/carrying up to 20 lbs**Bloodborne Pathogens:**Based on the OSHA guidelines for protection against occupational exposure to Hepatitis and HIV, this position is described as Category I. This means the position has exposure to blood and other body fluids. Policies are in place for Universal Precautions, exposure risk identification, and appropriate barrier protection.The above is intended to describe the general contract and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.## Qualifications**Education, Experience, Licensure/Certification requirements:*** Minimum High School diploma or equivalent* Minimum of two years related experience with patient accounts, billing/collections experience, preferably in a health care setting* Skilled in navigating multiple web-based applications, software platforms, and databases #J-18808-Ljbffr