Insurance Services Representative

Job Purpose:

We are seeking an experienced Insurance Services Representative to join our Joint Commission International accredited hospital system in New Providence, The Bahamas. The successful candidate maintains accurate information on all receivables. Monitors all receivables. Monitors admissions to the hospital. Follows up on delinquent accounts as needed. Communicate with internal and external customers on a regular basis. Answer patient queries in an informed manner and any other duties assigned by the Supervisor of Insurance Services. Continuously participate in performance improvements to enhance service to our customers throughout the Health System.

Essential Functions

• Report daily on insurance claim activities eg A/R receivables
• Tracking and preparing claim denial in a weekly tracker
• Tracking claims, submitted and unsubmitted
• Inspects claims for accuracy and sends them to Insurance Company/Companies for maximum reimbursement
• Process and submit all claims within the assigned portfolio for submission
• Detail reporting of patients admitted to the hospital and provide writing summary of verification.
• Uploading claims to the insurance company’s portal.
• Maintains a filing system for claim related information.
• Strong understanding of EOBs from the insurance company.
• Monitor and ensure that explanations of benefits (EOB’s) require action.
• Distribute explanation of benefits in a timely manner.
• Monitors claim data entered in the computer for accuracy.
• Follow-up on activity on claims/accounts unpaid 60 days from dispatch to the Carriers.
• Forward EOB’s secondary carrier for reimbursement after payment from primary.
• Develop good working relations with the various carriers to ensure prompt reimbursement.
• Respond to customer inquiries and assist in investigations concerning complaints on bills.
• Ensure payment information is accurate reclassified in the appropriate financial class.
• Prepare and provide monthly reports.
• Participate in performance improvement initiatives in the Insurance Services department.

QUALIFICATIONS AND EXPERIENCE:

• Relevant bachelor’s degree and/or CPC certification from the AAPC.
• Knowledge of ICD-10, HCPCS, CPT, Revenue Codes, and medical terminology.
• Experienced in health care claims processing.
• Well-organized with ability to prioritize
• Detail-oriented and problem-solving ability
• Very good communication and interpersonal skills
• Ability to meet deadlines
• Strong data creation and management skills
• Ability to work independently
• Excellent written and verbal communication skill
• Critical-thinking skills