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Altru Health System

Lead Insurance Representative

Career Insights for Medical Claims Processor / Representative

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Based on North Dakota data

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$45,209 / year median in North Dakota

-13% projected decline

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Job Description

Everything we do is underscored by a why — and that why is one another.
Location:
Altru Health System PO Box 6002 Grand Forks, ND 58201
Pay Range:
$18.82 - $28.23
Summary:
The Lead Insurance Representative assists patients with inquiries for the clinic and hospital billing system and reviews and submits insurance claims. The Representative processes and monitors insurance unpaid third party insurance. Must understand and be able to work account throughout the entire revenue cycle, ensuring proper payment is made. Secures necessary medical documentation require or requested by payers. This position is a resource and trainer for new and existing staff. They make sure to notify management when there are significate changes coming with payers. They report issues with the Epic system to supervisor so the system can be updated.
Essential Job Functions:
First contact with insurance companies to address issues with claims. First contact for all questions submitted via customer service ticketing system. Review payer updates and bring forth changes to update Epic system. Facilitate training and be a resource for insurance representatives. Reviews and monitors insurance unpaid third party insurance and denials to ensure proper payment. Evaluates and analyzes unpaid third party payments for trends. Tracks pending eligibilities and unpaid claims from the work queue. Works credit balances and under payment work queues. Reviews, edits, prepares and submits insurance claims to the appropriate party. Keeps up to date on all state/federal billing requirements and updates proper departments to ensure all processes are updated accordingly. Assists patients with their written, telephone or in person inquiries for the clinic and hospital billing system. Performs other duties as assigned or needed to meet the needs of the department/organization.
Education:
Preferred:
Associates -
Business Work Experience:
Required:
A minimum of 2 years
Related Experience Language Requirements:
This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.
Physical Demands :
Sit:
Frequently (34-66%) •
Stand:
Occasionally (5-33%) •
Walk:
Occasionally (5-33%) •
Stoop/Bend:
Occasionally (5-33%) •
Reach:
Frequently (34-66%) •
Crawl:
Not Applicable •
Squat/Crouch/Kneel:
Occasionally (5-33%) •
Twist:
Occasionally (5-33%) •
Handle/Finger/Feel:
Continuously (67-100%) •
See:
Continuously (67-100%) •
Hear:
Continuously (67-100%)
Weight Demands:
• Lift -Floor to
Waist Level:
Sedentary (