Patient Accounting Representative

Day (United States of America)

Patient Accounting Representative - BillingReview, process, bill, and follow up on claims to third-party payers. Pursue third-party resources in a persistent and timely manner. Effectively communicate with payers/guarantors for timely resolution of accounts. Make appropriate determinations for contractual adjustments.

- Minimum high school graduate or equivalent required. Associates or Bachelor’s degree from accredited institution is preferred.
- Minimum of two years experience in healthcare billing and/or business office setting, preferably in hospital billing.

·Demonstrates the ability to evaluate and resolve accounts by utilizing resources including, but not limited to, bills, remittances, correspondence, worklists and insurance calls in accordance to payer specific guidelines in a timely manner.

·Process insurance claims in a prompt and accurate manner, meeting all corresponding performance standards.

·Corrects and processes rejected and hardcopy claims in a timely manner.

·Prepares daily detailed status report of unprocessed claims to ensure timely follow up.

·Submits daily report of number of claims and dollars billed and ensures that department quality and quantity standards are met.

·Demonstrates proficiency in the billing systems and accounts receivable systems, keeping abreast of all changes.

·Maintains current knowledge of HCPC and UB04 coding in accordance with specific insurance payer guidelines.

·Maintains ability to bill specialty accounts which include, but not limited to, cycle bills, audit bills, split bills, DME, carve-outs, in-house denials, SDS, etc.

·Assists with appeals for technical denials as needed.

·Initiates timely appeals and reconsiderations with payers by telephone, letter, email or other electronic media or spreadsheets.

·Assist other departments perform claim analysis as needed.

·Assigns appropriate date to follow up with insurance carrier to ensure prompt payment.

·Updates billing and registration systems with any demographic/insurance revisions the same day received.

·Follows up on all denied, rejected and/or pending claims in a timely manner, utilizing all electronic means available.

·Analyze and follow up on any late charges credited or debited on accounts in accordance with established guidelines.

·Ensure account information is current by entering notes, documentation and changes at time of occurrence.

·Research and determines required adjustment information as deemed necessary in accordance with insurance payer.

·Identify and report data and collection trends/barriers to supervisor.

·Obtains and supplies insurance carriers with necessary account information to expedite payment.

·Meets and/or exceeds production goals as defined.

·Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with coworkers and customers.

·Mentors new employees within the revenue cycle.

·Duties as assigned.