Account Representative

Prime Healthcare•Harlingen, TX

17h•Onsite

About The Position

The Account Representative will be responsible for accurately posting and reconciling daily incoming payments, applying contractual adjustments, and maintaining correct patient account balances within hospital systems. This role involves analyzing insurance payments and managed care contracts to ensure accurate reimbursement and compliance with state and federal regulations. The representative will also identify, investigate, and escalate underpayments or denials, collaborating with payers and internal departments to optimize revenue collection. Additionally, the position entails distributing billing, managing hospital-related mail, and providing professional communication regarding account inquiries and payment matters.

Requirements

Ability to multi-task, prioritize needs to meet required timelines.
Effective written and verbal communication skills.
High School Graduate or GED Equivalent Required (effective 4/1/14 for all new hires).
Knowledge of basic understanding medical coding and third-party operating procedures and practices.
Medical and Insurance terminology essential.

Nice To Haves

Analytical, mathematical and problem-solving skill preferred.
Customer Services experience preferred.
Experience in accounts payable, accounts receivable or cashier experience preferred.
Familiar with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology is preferred.
Knowledge of multiple insurance billing requirements and 6 mo.-1 year of billing experience preferred.

Responsibilities

Accurately post and reconcile daily incoming payments, apply contractual adjustments, and maintain correct patient account balances within hospital systems.
Analyze insurance payments and managed care contracts to ensure accurate reimbursement and compliance with state and federal regulations, including Worker’s Compensation fee schedules.
Identify, investigate, and escalate underpayments or denials while collaborating with payers and internal departments to optimize revenue collection.
Distribute billing appropriately, manage hospital-related incoming and outgoing mail, and promptly correct mailing discrepancies.
Provide professional, tactful communication when assisting patients, families, and internal stakeholders regarding account inquiries and payment matters.