At The Portland Clinic our mission is to be a trusted community collaborating to improve the health and well-being of those we serve. Join our team and let us work together to offer a welcoming, inclusive environment for our patients and the communities we serve.
JOB TITLE: Insurance Representative
SUPERVISOR: Business Services Manager
HOURS PER WEEK: 40/Non-Exempt (Monday - Friday 8:00am - 5:00pm)
DEPARTMENT: Business Services
HIRING BONUS: $1,000 after 90 days
The following information is designed to outline the essential functions and position requirements of this job. It does not identify all tasks that may be expected, nor address the performance standards that must be maintained.
PRIMARY FUNCTION: Position is responsible for the management of insurance claim denials, file appeals to insurance, and work collaboratively with the revenue cycle team to prevent future denials. This role requires expertise in navigating medical insurance processes and experience in working with claims management.
DUTIES AND RESPONSIBILITIES: (*ESSENTIAL FUNCTIONS)
1. Review, analyze, and appeal insurance claim denials from various insurance companies. Take ownership of the resolution process by researching reasons for denials and coordinating corrective actions.*
2. Track and identify recurring denial patterns across multiple insurance providers. Utilize data analysis to highlight areas that need improvement and suggest preventative measures to reduce future denials.*
3. Work closely with registration, coding, and clinical departments to ensure proper documentation and coding practices that reduce the likelihood of denials. Provide feedback and training on best practices to prevent future errors.*
4. Regularly access and navigate insurance company websites to investigate denials and gather information to resolve issues efficiently. Utilize insurance portals to track claim status and appeals.*
5. Document denial resolutions and insurance correspondence to ensure the organization is following best practices.*
6. Manage and escalate complex claim denials as necessary. Develop and submit timely appeals to insurance carriers, ensuring compliance with policy guidelines and documentation requirements.*
7. Proactively engage in problem-solving and process improvement initiatives. Recommend changes to improve the claims process, reduce denials, and enhance overall revenue cycle efficiency.*
8. Serve as the main point of contact for insurance-related inquiries. Communicate effectively with insurance carriers, clinic staff, and patients to ensure timely and accurate resolution of claims.*
9. Perform additional duties as requested by Supervisor.*
10. Participate as an active team member in a patient-centered medical home.*
11. Employees will not be discourteous or disrespectful to a customer or any member of the public while in the course and scope of company business.*
12. Work in a cooperative manner with management/supervision, coworkers, customers and vendors.*
13. Abide by company policies.*
14. Maintain regular, in person, work attendance and punctuality, as scheduled. *
REQUIREMENTS:
⦁ High School Diploma or equivalent
PREFERENCES:
⦁ 3+ years of experience working with insurance claims in a healthcare setting (preferably in a clinic or physician practice).
⦁ Strong understanding of insurance denials, appeals, and claims processing procedures.
⦁ Excellent analytical skills to identify trends and issues in claims data.
⦁ Ability to communicate effectively with insurance companies and internal departments.
⦁ Solid organizational skills and attention to detail.
⦁ Experience with the Epic medical records system.
⦁ Familiarity with the use of insurance company websites and portals for claims investigation and resolution.
⦁ Knowledge of medical coding (CPT, ICD-10) and healthcare billing practices.
⦁ Strong problem-solving skills with the ability to work independently and as part of a team.
⦁ Experience with Microsoft Excel or other data analysis tools to track and report denial trends.
COMPENSATION AND BENEFITS (Benefits eligibility begins at 20hrs/wk):
⦁ 401k plan with Employer Matching up to 4.5% annually
⦁ Roth IRA
⦁ Comprehensive Medical, Dental and Vision insurance
⦁ Flexible Spending Account
⦁ Health Savings Account
⦁ Company provided $10K Group Life/AD&D insurance
⦁ Voluntary benefits: Life/AD&D, Dependent Life/AD&D, Short-Term Disability, Critical Illness, Accident, and Hospital Indemnity
⦁ Norton Identity Theft Protection (optional)
⦁ Pet Insurance (optional)
⦁ 4.92 hours of PTO accrual per pay period (PTO accrual is prorated based upon FTE)
⦁ One paid Wellness day per year
⦁ Seven paid holidays, and 1 partially paid holiday (mid-day closure)
⦁ Employee Assistant Program