Insurance Research Representative

Role Details

Job Summary:

• The Insurance Research Representative is primarily responsible for verifying and updating insurance information accurately through manual and system generated eligibility checks.

Essential Functions and Tasks:

• Reviews eligibility responses from the system generated eligibility checks and updates the incorrect/missing information.

• Performs manual eligibility checks to find information not obtained during system generated checks.

• Analyze Explanation of Benefits to determine rejection type, provide an accurate solution, and refile the claim appropriately.

• Corrects any errors based on insurance billing requirements.

• Adds and maintains insurance information within system through proper research.

• Identifies any ‘Red Flag’ issues and provides proper research to deliver a solution.

• Provides support for any major projects within department.

• Performs special projects and other duties as assigned.

Education and Experience Requirements:

• High School Diploma or Equivalent.

• Six (6) months of experience with insurance/professional medical billing and electronic filing process, preferred.

Knowledge, Skills, and Abilities (KSA's):

• Working knowledge of medical terminology, anatomy and physiology, legal aspects of health information

• Knowledge of Coordination of Benefits (COB), Workers’ Compensation laws and auto laws related to insurance billing

• Ability to read and understand an Explanation of Benefits from an insurance company.

• Strong organizational skills

• Strong time management skills

• Strong word processing, spreadsheet, database, and presentation software skills

• Strong oral, written, and interpersonal communication skills

• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions

• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately

• Ability to remain flexible and work within a collaborative and fast paced environment

• Ability to communicate with diverse personalities in a tactful, mature, and professional manner

IND1

Requisition ID: 2022-2019

External Company Name: Ventra Health, Inc.

External Company URL: www.ventrahealth.com

Qualifications:

Education and Experience Requirements:

• High School Diploma or Equivalent.

• Six (6) months of experience with insurance/professional medical billing and electronic filing process, preferred.

Knowledge, Skills, and Abilities (KSA's):

• Working knowledge of medical terminology, anatomy and physiology, legal aspects of health information

• Knowledge of Coordination of Benefits (COB), Workers’ Compensation laws and auto laws related to insurance billing

• Ability to read and understand an Explanation of Benefits from an insurance company.

• Strong organizational skills

• Strong time management skills

• Strong word processing, spreadsheet, database, and presentation software skills

• Strong oral, written, and interpersonal communication skills

• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions

• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately

• Ability to remain flexible and work within a collaborative and fast paced environment

• Ability to communicate with diverse personalities in a tactful, mature, and professional manner

IND1

Ventra Health, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.