Remote Insurance Rep

Job Purpose:

The Insurance Representative at PFS Group under the supervision of the Insurance Supervisor, the Insurance Representative manages insurance claims to ensure timely and accurate reimbursement. The role involves researching unpaid balances, correcting billing issues, submitting appeals, and communicating with insurers, patients, and internal teams to resolve discrepancies. Strong knowledge of insurance guidelines, billing systems, and effective accounts receivable management is essential, with responsibility for managing assigned inventories based on client needs.

Key Responsibilities:​​

• Initiates contact with insurance payers to collect contracted rates on outstanding claims
• Reviews, monitors and effectively reduces aged inventory
• Successfully identifies root causes for denials or non-payment, prioritizing collection metrics in all work efforts
• Ensures timely filing deadlines are achieved according to payer guidelines
• Monitors accounts for updates on claims processing, taking care to resolve balances with single interventions whenever possible
• Request appropriate claim corrections and rebill as needed
• Informs supervisor of trends noticed when working insurance inventory
• Interpret payment variances and payer guidelines to monitor for underpayment opportunities
• Contacts guarantors as needed to resolve coverage discrepancies
• Corrects adjustments as needed to ensure balances are accurately documented

Provides revenue cycle management and patient billing services.