Health Insurance Representative

Champion Accuracy, Care, and Balance in Every Claim

Step into the healthcare revenue cycle industry, where precision supports compassion and every claim you resolve helps keep care moving. Build a meaningful career improving the financial heartbeat of hospitals and clinics, while enjoying the rhythm of real work-life balance that lets you recharge beyond the charts.

Job Description

As a
Health Insurance Representative,
you'll manage outstanding accounts receivable by pursuing timely and accurate payments from insurance carriers and patients. You'll resolve denials, investigate claims, and ensure compliance with payer guidelines-all while supporting the financial health of healthcare providers.

Job Overview

Employment type: Full-time

Shift: Day Shift, Monday - Friday, 8 AM - 5 PM EST, Weekends Off

Work setup: Onsite, Bogotá

Exciting Perks Await

• 5-day work week
• Weekends off
• 20 vacation days in total
• Prepaid medicine
• Fully customized Emapta laptop and peripherals
• Indefinite term contract
• Direct client exposure
• Career growth opportunities
• Diverse and supportive work environment
• Prime office locations in Bogotá and Medellin
• Unlimited upskilling through Emapta Academy courses (Visit
  
  )

The Qualifications We Seek

• Minimum 3+ years of experience
  in
  medical billing or insurance follow-up
  , preferably in a healthcare or hospital setting
• Strong understanding of
  insurance payers, claim life cycles, and denial management
• Proficiency with
  CMS-1500, CPT, HCPCS, ICD-10, EOBs, and payer-specific policies
• Rural Health Clinic experience preferred
• Experience using systems such as
  Epic, Cerner, Meditech, SSI, IDX/Centricity, Athena, Keane, etc.
• Strong organizational and communication skills with the ability to manage multiple tasks independently
• High school diploma or equivalent required; associate degree preferred
• Preferred certifications:
  Certified Revenue Cycle Representative (CRCR) - HFMA, Certified
  Professional Biller (CPB) - AAPC,
  or
  Certified Medical Reimbursement Specialist (CMRS) - AMBA
• Understanding of and adherence to
  HIPAA and other regulatory compliance requirements

Physical Requirements:

• Comfortable working at a computer for extended periods
• Ability to occasionally lift items weighing up to 15 pounds

Your Daily Tasks

• Denial Resolution and Appeals
• Perform follow-up on outstanding insurance and patient balances using payer portals, phone calls, and correspondences
• Analyze denials to uncover trends and root causes and recommend process improvements
• Monitor assigned worklists or aging reports to ensure timely follow-up on all accounts
• Investigate and follow up on unpaid or denied claims to ensure timely reimbursement
• Review insurance remittance advice (EOBs/ERAs) to determine necessary actions
• Initiate reconsiderations and resubmissions as required
• Submit appeals and corrected claims with appropriate documentation based on payer-specific guidelines and deadlines
• Follow-Up and Review
• Communicate with insurance payers to resolve issues such as medical necessity, authorization, bundling, and eligibility rejections
• Contact patients to verify or obtain insurance information as needed
• Underpayment Review
• Identify underpaid claims based on contract expectations
• Research and dispute underpayments with payers, collaborating with contract management when necessary
• Process and Workflow
• Accurately document all actions taken within the appropriate workflow management system
• Utilize internal resources including crosswalks, tip sheets, and team chats
• Escalate unresolved issues appropriately to ensure timely resolution
• Adhere to productivity and quality standards
• Support onboarding of new team members with payer and system-specific training
• Work independently and as part of a team in a fast-paced environment
• Collaboration and Strategy
• Collaborate with coding, patient access, billing, compliance, and internal teams to resolve root causes of denials
• Ensure compliance with CMS, Medicaid, and commercial payer guidelines
• Support teammates in achieving collective goals and client success
• Recommend process improvements based on denial trends and payer behavior
• Maintain strong communication and analytical skills to drive results

About the Client

Driving Healthcare Efficiency Through Expert Claim Resolution

Our client is
a trusted healthcare revenue cycle partner dedicated to optimizing financial performance for hospitals and medical providers.
With a focus on accuracy, compliance, and innovation, they help clients reduce denials, improve cash flow, and strengthen operational excellence-empowering healthcare professionals to focus on patient care.

Welcome to Emapta Colombia

At Emapta, you're not just joining an industry-leading outsourcing provider; you're becoming part of a community that celebrates the rich cultural tapestry of Colombia. Our track record of success and diverse international clientele across various industries provide a solid foundation for your career. With over 1,000 global partners preferring to open remote jobs in the country, our vision is to help you and thousands more Colombians reach your full potential and dreams without the need to leave the country and work abroad.

Join forces with passionate professionals who share the desire to make a meaningful impact through premium global opportunities, all at your fingertips. Emapta isn't just a company; it's a community that values the balance between work and life. Start a truly exciting journey with us and discover how your talent can flourish in a setting that celebrates the spirit of Latin America.

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