Insurance Representative in Medford, Oregon at Southern Oregon Orthopedics, Inc

Supports insurance account resolution, payer communications, claim follow-up, and timely reimbursement.

Essential Functions

• Review assigned insurance accounts and identify outstanding claims, denials, or underpayments.
• Contact payers to verify claim status and resolve processing issues.
• Investigate denials and coordinate corrections, reconsiderations, or appeals as assigned.
• Document payer contacts and follow-up actions in Epic or the designated system.
• Identify coverage, coordination-of-benefits, and claim submission issues.
• Collaborate with coding, billing and authorization staff to resolve account discrepancies.
• Monitor assigned work queues and meet department follow-up standards.
• Escalate complex or recurring payer issues to management.
• Take patient payments.
• Answer billing line patient questions.
• Completes other duties and special projects as assigned by Manager/Lead.

General Expectations

Perform assigned duties in accordance with clinic policies, applicable laws, payer requirements, and documented procedures. Provide reasonable cross-coverage and perform related duties as assigned. This description summarizes the position and is not an exhaustive list of every task.

Minimum Qualifications

• High school diploma or equivalent required unless an approved alternative is established.
• Experience with medical insurance claims, payer portals, and healthcare revenue cycle processes preferred.
• Ability to learn and use electronic health records, payer tools, and applicable clinic workflows.

Knowledge, Skills & Abilities

• Accurate data entry, sound judgment, confidentiality, and attention to detail.
• Professional communication and collaboration with patients, payers, providers, and colleagues.
• Ability to prioritize assigned work, meet deadlines, and escalate issues appropriately.
• Knowledge of HIPAA privacy and security practices relevant to assigned duties.

Physical Demands & Work Environment

Primarily office/clinic-based work involving extended computer use, telephone communication, repetitive keyboarding, and occasional movement or handling of office materials. Reasonable accommodation may be available for qualified individuals. Specific requirements should be validated for the worksite.

Equal Employment Opportunity

Southern Oregon Orthopedics Inc. is an equal opportunity employer and complies with all applicable federal, state, and local employment laws. Employment decisions are based on qualifications, merit, and organizational needs.