Insurance Representative Lead

• Supporting the daily operations of the Insurance Representatives (IR) team while serving as a subject matter expert for claim follow-up, denial management, and revenue recovery activities
• Providing guidance, training, and support to our IR team
• Assisting with workflow management
• Monitoring productivity and quality metrics
• Serving as a liaison between staff and leadership to ensure timely resolution of outstanding accounts
• Serving as a resource, mentor and subject matter expert for IRs, providing guidance on complex claim issues, payer policies, and revenue cycle processes
• Assisting with onboarding, training, and ongoing development through performance feedback and quality audits of IR staff
• Monitoring work queues, workload distribution and departmental productivity to ensure timely claim resolution and aging goals
• Reviewing and analyzing denied, underpaid, and unpaid claims to identify root causes, trends and reimbursement opportunities
• Escalating payer issues, system concerns, workflow issues and collaborating with internal teams to resolve barriers to management as appropriate
• Tracking and reporting trends related to denials, payment delays, and reimbursement opportunities
• Supporting with special projects, payer audits, appeals initiatives, and revenue recovery efforts
• Maintaining current knowledge of payer regulations, reimbursement guidelines, and revenue cycle best practices
• Participating in meetings and providing recommendations for process improvements

• High School Diploma or GED required
• Minimum of 2-4 years of medical billing receivable experience required
• Previous experience in physician practice, healthcare revenue cycle, or medical billing environment required
• Lead, trainer, or supervisory experience preferred
• Experience with denial management, appeals, payer follow-up, and reimbursement analysis required
• Strong understanding and knowledge of commercial plans, Medicare, Medicaid, and managed care reimbursement methodologies
• Familiarity with CPT, ICD-10, HCPCS, and medical coding concepts
• Strong analytical and problem-solving skills
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
• Excellent verbal and written communication skills
• Proficiency in Microsoft Office applications, particularly Excel
• Experience with electronic medical record (EMR) and practice management systems
• Ability to effectively coach, mentor, and develop team members
• Strong attention to detail and organizational skills

Lead, trainer, or supervisory experience preferred

• Medical insurance with prescription drug coverage
• Dental insurance
• Vision insurance
• Company-paid basic life insurance
• 401(k) with company match
• Dependent Care Flexible Spending Account
• Healthcare Flexible Spending Account
• Paid time off