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Posted: July 10, 2024
Salary:US$18 - US$20 per hour
Location:Grand Junction
Job type: Permanent
Discipline:Revenue Cycle
Work Location:Remote

Job description

This position is fully remote with equipment provided.

Please only apply if you live in the following states:

  • NC
  • CO
  • MA
  • NC
  • GA
  • FL
  • TN
  • TX
  • AZ
  • KY

Pay: $18-$20

Schedule: M-F 8am-5pm PST; 11am-8pm EST (some flexibility here if needed)

Job Description Summary:

We are seeking a dedicated and detail-oriented Insurance Account Representative to manage a portfolio of accounts within our Client Partner's Government, Non-Government, TPL, or Worker's Compensation Accounts Receivable. This role is crucial in ensuring the rapid, compliant, and patient-centric resolution of balances, ultimately maximizing our Client Partner's financial performance.

Key Responsibilities:

  • Utilize knowledge of managed care contracts, payer behaviors, and clean claim statutes to influence payer intent and overcome payment delays or objections.
  • Understand expected reimbursement for assigned payers; identify and resolve payment discrepancies.
  • Submit and re-submit UB-04, 1500, and other claim forms, accurately completing each field locator and attaching necessary documentation (e.g., itemized statements, medical records).
  • Collaborate with payers and patients to resolve coverage, coordination of benefits, and authorization issues impacting claim resolution.
  • Manage the printing and mailing of claims.
  • Consistently document all payer and patient interactions in the hospital's source system and/or Excalibur's workflow solution.

Skill Sets and Experience:

  • Proficient with UB-04 and CMS 1500 forms.
  • Comprehensive knowledge of government and non-government payers.
  • Experience with EMR systems (Epic, Cerner, Meditech preferred).
  • Expertise in insurance follow-up, payer behavior, and guidelines.
  • Ability to toggle between multiple systems and maintain organizational efficiency.
  • Excellent documentation, written, and verbal communication skills.
  • Proficiency in Microsoft Office products including Outlook, Word, and Excel.
  • Understanding of HIPAA and related privacy and security regulations.
  • Team player with a passion for healthcare.


  • High School Diploma or equivalent is required.

Must Have Skills/Qualifications:

  • Experience with both in-patient and out-patient claims.
  • Knowledge of Medicare/Medicare Advantage and commercial claims.
  • Proficiency with both UB-04 and 1500 claim forms.
  • A minimum of 2+ years of relevant experience.

Additional Information on Responsibilities:

  • Billing for all payors, including Medicare/Medicare Advantage and commercial claims.
  • Managing claims for both in-patient and out-patient services.
  • Utilizing claim scrubbers, correcting edits, and ensuring timely claim submission.
  • Handling a backlog from the Trizetto transition.
  • Managing an average of 45 claims per day, with volume depending on claim value.
  • Following up with providers to ensure timely claim payments.
  • Working complex denials for all payers and processing adjustment requests.
  • Processing appeals and denials, using templates or free-style as needed.
  • No direct patient communication; patient-related issues are handled by the patient accounts team.
  • Working with UB-04 and 1500 claim forms within the Cerner EMR system.

If you have the skills and experience required for this role and are passionate about making a difference in healthcare, we encourage you to apply.