Insurance Services Representative

Job Summary and Responsibilities

As an Insurance Services Representative, you will provide essential support and expert guidance to clients regarding their insurance coverage, ensuring clear understanding and seamless service.Every day you will expertly process inquiries, explain policy details, assist with claims submission, and meticulously update account information, ensuring accurate and efficient client interactions.To be successful, you will demonstrate outstanding communication skills, strong problem-solving abilities, and a patient, customer-focused demeanor, contributing to client satisfaction and retention.

• Researches, reviews, and resolves rejected, denied, underpaid, or incorrectly paid claims by analyzing account details, insurance EOBs, denial reason codes, payer requirements, and reimbursement policies to maximize appropriate revenue recovery within established timelines.
• Utilizes work queues, payer portals, spreadsheets, and practice management systems to prioritize accounts, determine next steps, organize denials by payer/type, resubmit claims electronically or via hardcopy, and enter appropriate billing corrections to ensure accurate reimbursement.
• Contacts insurance companies, payers, clinics, and other stakeholders to obtain necessary information, reopen claims when appropriate, resolve payment discrepancies within scope, and expedite prompt and accurate claim payment resolution.
• Documents all account activity, claim history, corrections, communications, and follow-up actions accurately and thoroughly within Epic and billing systems while maintaining compliance, confidentiality, and integrity of medical records and account documentation.
• Maintains current knowledge of billing regulations, reimbursement methodologies, government and commercial payer policies, denial management practices, payment adjustment codes, and departmental procedures to ensure quality, accuracy, and compliance standards are consistently met.
• Establishes and maintains collaborative and professional relationships with revenue cycle teams, clinics, FMG staff, payers, and other stakeholders while effectively communicating denial, underpayment, and outstanding balance issues and escalating complex accounts appropriately when additional assistance is needed.

Job Requirements

Required

• One year of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities or
• Post-high school education in a field (e.g. medical billing) that would demonstrate attainment of the requisite job knowledge/abilities may be substituted, on a month-for-month basis, for the experience requirement, upon hire

Where You’ll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.