Insurance Representative Lead

Essential Duties and Responsibilities

• Serve as a resource, mentor and subject matter expert for IRs, providing guidance on complex claim issues, payer policies, and revenue cycle processes.
• Assist with onboarding, training, and ongoing development through performance feedback and quality audits of IR staff.
• Monitor work queues, workload distribution and departmental productivity to ensure timely claim resolution and aging goals.
• Review and analyze denied, underpaid, and unpaid claims to identify root causes, trends and reimbursement opportunities.
• Escalate payer issues, system concerns, workflow issues and collaborate with internal teams to resolve barriers to management as appropriate.
• Track and report trends related to denials, payment delays, and reimbursement opportunities.
• Support with special projects, payer audits, appeals initiatives, and revenue recovery efforts.
• Maintain current knowledge of payer regulations, reimbursement guidelines, and revenue cycle best practices.
• Participate in meetings and provide recommendations for process improvements.

Qualifications

• Education: High School Diploma or GED required.
• Experience: 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.
• Knowledge, Skills, and Abilities: 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.

Performance Expectations

• Maintain productivity and quality standards established by leadership.
• Achieve departmental aging and reimbursement goals.
• Demonstrate leadership through accountability, teamwork, and professional conduct.
• Promote a positive work environment focused on continuous improvement and operational excellence.
• Support organizational initiatives and contribute to overall revenue cycle performance.

Physical Requirements

• Prolonged periods of sitting and working at a computer.
• Ability to communicate effectively via telephone, video conference, and in person.

BENEFITS

• 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