INSURANCE REPRESENTATIVE

The Insurance Representation role plays an integral part in the success of our large, multi-physician Orthopaedic and Sports Medicine practice, as well as our Ambulatory Surgical Center. This position may be responsible for and assigned to a variety of insurance- and revenue-related functional areas, depending on the needs of the organization and the individual’s experience.

The ideal candidate is a self-starter who demonstrates a strong sense of ownership and urgency regarding assigned responsibilities. This individual must be a team player with an energetic, positive attitude and a commitment to accuracy, efficiency, and collaboration. A complete list of essential functions is outlined below.

Characteristics of Work

This position requires strong industry knowledge of insurance processes, revenue cycle management, and best practices. The individual in this role must demonstrate initiative, accountability, and attention to detail. Collaboration with management and team members to identify and resolve issues at their source is an essential component of this position.

Experience / Educational Requirements

• High School Diploma or equivalent required
• Minimum of 2 years of healthcare physician revenue cycle experience related to the duties described
• Orthopaedic billing experience strongly preferred
• Ambulatory Surgery Center billing experience strongly preferred
• Experience with ModMed and/or HST EMR systems strongly desired

Essential Functions

• Demonstrate an understanding of revenue cycle–related code sets, including CPT, HCPCS, and CARC/RARC
• Understand managed care and governmental insurance rates and requirements related to fees and prior authorizations
• Maintain appropriate levels of accuracy and daily productivity
• Respond to patient and insurance company inquiries in a professional and courteous manner
• Verify insurance benefits and ensure accurate data entry
• Perform timely follow-up on insurance claims, including rejections and denials, to secure prompt payment
• Obtain and enter referrals and pre-certifications for planned services and visits
• Work independently while maintaining focus and efficiency
• Identify trends or issues impacting timely claim resolution and proactively bring them to management’s attention