Description

The Position:

This position leads Insurance Services operations to secure timely, accurate, and compliant reimbursement from commercial, government, and managed care payers. Oversees claim follow-up, denial prevention and resolution, prior authorization support, underpayment review, payer escalation, reimbursement monitoring, and payer relations. Uses data, process improvement, and cross-functional collaboration to reduce claim delays, improve cash flow, support compliance, and advance revenue cycle objectives.

Schedule:
Core business hours for this position are Monday - Friday, between the hours of 7:30am and 5:00pm with flexibility to attend meetings outside core business hours on occasion.

Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing
• Flexible Paid Time Off Program (29 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Essential Functions and Responsibilities:

• Lead and develop Insurance Services staff, including recruitment, onboarding, training, coaching, performance evaluation, engagement, and professional development. Set and monitor productivity, quality, accuracy, timeliness, and service expectations. Address performance issues, support succession planning, and promote accountability, continuous improvement, and service excellence.
• Oversee insurance follow-up, denial resolution, appeals, underpayment recovery, and reimbursement issue resolution. Analyze denial and aging trends, identify root causes, and implement corrective action with providers, clinical leadership, coding, registration, billing, and other revenue cycle teams to improve first-pass accuracy and reimbursement outcomes.
• Track, analyze, and report key revenue cycle indicators, including insurance A/R, denial trends, appeal outcomes, payer turnaround, underpayment trends, productivity, quality, clean-claim performance, and reimbursement results. Prepare leadership reports and recommend workflow, staffing, training, or payer escalation strategies.
• Serve as the primary operational contact for insurance carriers, managed care organizations, and governmental payers. Coordinate payer issue resolution, reimbursement analysis, contract-related payment concerns, policy clarification, and escalation discussions. Monitor payer policy changes and communicate operational impacts to affected departments.
• Manage payer- and insurance-related correspondence, escalated patient complaints, operational reports, and required records. Ensure issues are resolved timely and documented appropriately.
• Perform administrative duties, including budget input, meeting participation, staff/resource planning, data compilation, and operational reporting.
• Maintain departmental policies, procedures, workflows, and internal controls to support payer, Medicare, Medicaid, HIPAA, and other applicable requirements. Coordinate staff education, corrective action, and process updates when compliance concerns or audit findings are identified.
• Complete all other assigned projects and duties.

Knowledge & Skills:

Experience Three years to five years of similar or related experience.

Education Equivalent to a two-year college degree or completion of a specialized course of study or certification at a business or trade school. Bachelor's degree is strongly preferred.

Interpersonal Skills A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.

Physical Aspects:

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Feeling - Perceiving attributes of objects, such as size, shape, temperature or texture by touching with skin, particularly that of fingertips.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Vision - 20 / 40 or better in the best eye with or without correction.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.