Insurance Representative, Healthcare Administration

Job Summary

The Insurance Representative is responsible for analyzing, investigating, following up on denied and/or underpaid claims, as well as patient balances, to facilitate payment and resolution with patient accounts.

• Review claim issues to determine the accuracy of reimbursement payments.
• Provide medical records and/or other requests to substantiate payment of claims to insurance payers.
• Review and resolve assigned tasks in the Unity/Centricity queue.
• Able to organize and prioritize tasks to complete all work assigned in a timely manner.
• Routinely monitor all high balance accounts to ensure follow up activity.
• Develop monthly action plans to lower A/R and increase cash flow.
• Answer all patient calls professionally to help resolve any claims or billing questions.
• Inform departmental leadership of any insurance related issues of importance.
• Maintain patient and clinic confidentiality and adhere to clinical standards, policies, & procedures.
• Maintain a professional relationship with physician teams.
• Maintain a pleasant/helpful attitude towards patients and staff.
• Perform all related duties as required by Revenue Cycle Manager(s), Business Office Director, CFO, and CEO.

• Knowledge of billing policies and regulations
• Knowledge of g4/PM System, Onbase, and Availity.
• Knowledge and experience with CPT, ICD-10-CM, HCPCS codes and EMR systems.
• Knowledge of medical terminology and medical oncology treatment course.
• Knowledge of Medicare guidelines and coverage determinations (LCD, NCD, etc.).
• Ability to adapt to changing billing requirements by CMS.
• Understanding of claims appeal process.
• Ability to work in MS Office environment.
• Ability to handle multiple and conflicting priorities.
• Ability to work independently and collaboratively within a team environment.
• Ability to maintain good working relationships.
• Demonstrates attention to detail.
• Demonstrates professionalism in appearance/dress code.

• High School Diploma or equivalent.
• Minimum of 1-2 years of medical office experience, preferred.
• Insurance and billing experience preferred.

• Will require extensive desk use and computer use.
• Long periods of sitting.
• Moderate walking, bending, squatting within the scope of normal office functions.
• Light lifting may be required up to 25 pounds.

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
• Due to the nature of our business and the use of radiation and hazardous chemicals, it is imperative that all employees foster a culture and environment of safety.
• Safety Sensitive:
  In accordance with Arkansas code this position is designated as a safety sensitive position wherein the employee performing the job duties under the influence may constitute a threat to health or safety.

Highlands Oncology offers a full suite of benefits that includes those listed below and MANY MORE!

• Certified as a Great Place to Work.