Sanford Health Insurance Representative - Pharmacy Admin in Fargo, North Dakota

Job Title: Insurance Representative | Pharmacy Admin | Fargo

City: Fargo

State: North Dakota

Department : Pharmacy Admin

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

The Insurance Representative processes and monitors unpaid third party insurance, Medicare, Medicaid or government-assisted program accounts for proper reimbursement. Must understand and be able to work accounts throughout the entire revenue cycle. Prepares and submits claims to payers either electronically or by paper. Secures necessary medical documentation required or requested by payers. Proactively identifies and performs account follow-up on outstanding insurance balances and takes the necessary action for account resolution in accordance with established federal and state regulations. Completes work within authorized time to assure compliance with departmental standards. Keeps updated on all state/federal billing requirements and changes for insurance types within area of responsibility. Understands edits and appropriate department procedures to effectively submit and/or correct errors on claims. Processes and resolves denials. Uses advanced knowledge and understanding to process payer rejections. Conducts trend analyses, appeals and resolves low payment or underpaid accounts. Provides input for payer-specific meetings. Handles difficult account situations and resolves issues delaying or preventing payments from payers. Performs miscellaneous job related duties as requested. Consistently demonstrates accuracy in correcting (identified through pre-edits) and submitting claims to payers. Ensures accounts are billed in timely manner. Consistently reports to a manager any accounts that cannot be finished in a timely manner. When claims are disputed, consistently utilizes the correct resources to ensure the completion of the claim. Accurately and completely follows claim through entire billing process. Ensures all claims consistently meet compliance regulations. Demonstrates accountability by consistently using appropriate resources and channels to problem solve issues. Consistently demonstrates ability to input data accurately into the computer system. Consistently answers the telephone courteously. Maintains and updates computer skills as needed for work assignments. Demonstrates the ability to utilize software applications for maximum efficiency. Consistently ensures verbal communication is courteous, complete, and professional whether using phone or personal contact. Consistently ensures written communication is accurate, complete and professional in presentation whether word processing or using email. Identifies and promptly resolves billing complaints. Directs issues to supervisor when unable to resolve. Documents in computer system all contacts regarding patient accounts.

POSITION RESPONSIBILITIES

Review records for completeness, accuracy, and compliance with regulations. Verify accuracy of billing data and revise any errors. Completes current work according to assigned priorities. Recognizes, clarifies, and prioritizes concerns. Processes limited amounts of detailed information with good accuracy.

DEPARTMENT DETAILS

The hours for this position are 8-5 p.m. with a flexible lunch break.

QUALIFICATIONS

High school diploma or high school equivalency required; post-secondary or trade courses in accounting, business, and communications would be helpful for this position. Six months' experience as an Associate Insurance Representative at Sanford Health required. Computer skills essential.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community,

across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

In compliance with federal law requiring employers to verify new employees' U.S.

employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Fargo

State: North Dakota

Job Function: Revenue Cycle

Job Schedule: Full Time

Shift: Days

Req Number: req25417