Job Summary:
The Insurance Account Representative manages a portfolio of accounts within Excalibur’s client partners’ Government, Commercial, Third-Party Liability (TPL), and Workers’ Compensation Accounts Receivable in a hospital or health system environment. This role is integral to the end-to-end revenue cycle, with a strong focus on resolving complex insurance balances and optimizing reimbursement.

This position is responsible for the timely, compliant, and patient-centered resolution of outstanding accounts while supporting overall financial performance. The Insurance Account Representative plays a key role in denial management, underpayment recovery, and accounts receivable (A/R) reduction, ensuring alignment with hospital financial and regulatory standards.

Key Responsibilities:

• Perform comprehensive follow-up on assigned insurance accounts via payer portals, clearinghouses, and outbound calls to ensure timely resolution and reimbursement
• Analyze payer reimbursement methodologies (DRG, APC, fee schedules) and apply contract knowledge to resolve claims efficiently
• Identify, investigate, and resolve denials, underpayments, and payment discrepancies; implement strategies to prevent recurring issues
• Prepare and submit/re-submit claims (UB-04, CMS-1500) with a high degree of accuracy, ensuring proper coding, documentation, and compliance with billing requirements
• Collaborate with payers, patients, and internal departments (e.g., coding, case management, patient access) to resolve eligibility, authorization, and coverage issues
• Manage claim inventory, including electronic and manual submission processes, while adhering to timely filing guidelines
• Maintain accurate, audit-ready documentation of all account activity within client systems and Excalibur workflow tools

Required Skills & Qualifications:

• Strong knowledge of hospital billing practices, including UB-04 and CMS-1500 claim forms
• In-depth understanding of the healthcare revenue cycle, particularly insurance follow-up and denial resolution
• Familiarity with payer guidelines, reimbursement structures, and managed care contracts
• Ability to navigate multiple systems (EMR, billing platforms, payer portals) with efficiency and accuracy
• Excellent written and verbal communication skills, including experience handling payer escalations
• Strong attention to detail, analytical thinking, and problem-solving abilities
• Patient-focused mindset with an understanding of the financial patient experience
• Ability to work both independently and collaboratively in a team environment

Preferred Qualifications:

• Experience working with Medicare, Medicaid, and commercial payers in a hospital setting
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
• Knowledge of HIPAA and healthcare compliance regulations
• Proven ability to collaborate effectively with cross-functional teams and hospital leadership
• Demonstrated commitment to excellence in revenue cycle operations

Education:

• High School Diploma or equivalent required

Job Type: Full-time

Pay: $18.00 - $26.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• What payers are you most familiar with?
• Are you familiar with HB, PB, or both? Please explain experience.
• What EMR systems are you familiar with?

Experience:

• Insurance Follow Up : 2 years (Required)

Work Location: Remote