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Job Description

Job Requisition Number 21460

Full-Time, 40 Hours/Week

8:00am to 4:30pm



The representative utilizes telephone, email, and letters for verbal and written communication when providing assistance for families and insurances with all concerns and complaints regarding hospital and/or physician services. Documents interactions and transactions; details of inquiries; complaints and comments; and actions taken


  1. Responsible for the timely and accurate updating and processing of patient registration, and insurance information.
  2. Responsible for investigating current insurance eligibility information through web sites established by Third Party Insurance and Governmental Payers to locate accurate information needed for timely claims submission.  
  3. When questioned can review patient accounts that are denied by the insurance companies. 
  4. Facilitate further investigation of denied claims to determine if denial may have been appropriate.  If denial is inappropriate accounts are returned to applicable team members to appeal with the insurance for reconsideration and ultimate payment.   
  5. Identifies denial trends and works with administrators or managers of various Hospital Departments.
  6. Responsible to inform leadership of denial trend information and work with them towards a resolution. 
  7. Meets with coding representatives to identify and resolve denial trends.
  8. Shares information regarding denial trends with Managed Care Department to resolve payment issues at the contract level.
  9. Responsible for promoting positive internal and external relationships while providing superior customer service.
  10. May performs financial screening of guarantors and assist families with the application process for HCAP/Charity. 
  11. Must have an understanding of health benefits and services rendered to identify the root cause/complaint/issue. 
  12. Read/interpret and provide guidance to guarantors related to payer EOBs. 
  13. May be responsible for the collection of self pay accounts billed for services, including establishing payment arrangements.
  14. May be called as hospital representative for legal collection cases and may be required to testify at court hearings.
  15. Triage and escalate complaints and patient care issues trending as appropriate.
  16. Responsible for special projects that support the Revenue Cycle process.
  17. Create and maintain spreadsheets for projects as needed.
  18. Other duties as assigned.

Other information:

High school graduate or equivalent required.  One (1) year experience in a physician/hospital billing setting required, three (3) years preferred.  Must have strong interpersonal skills as required to handle sensitive and confidential information. Must have above average communication and organizational skills to communicate verbally, prepare written communications for patients, patient families, physicians, third party payors, collection agencies, attorneys and other staff members.  Prior experience in processing personal and confidential data when updating demographic and medical insurance information.  Is proficient in utilizing third party and governmental web sites to locate accurate information needed for timely submissions of coverage and claim processing.

Must have experience with computerized physician/hospital systems. Ability to process large amounts of data in a timely manner, executes projects, create and maintain spreadsheets. Thorough knowledge of medical terminology and ICD9/10 CPT coding preferred.  Ability to demonstrate professionalism, strong customer service and analytical skills. Highly developed attention to detail with ability to cross train to other functions as necessary.  Numerical aptitude and the ability to exhibit proficient personal computer skills including, but not limited to, Microsoft Word and Excel is required. Must be results oriented and able to work independently to set priorities. Employee has a tremendous responsibility to the people we serve. Individuals who share these values and who are driven to make a difference will be considered for this position Prior EPIC experience a plus.

Full Time

FTE: 1.000000

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