Account Representative

Prime Healthcare•Harlingen, TX

7d•Onsite

About The Position

The Account Representative is responsible for accurately posting and reconciling daily payments, applying contractual adjustments, and ensuring patient accounts reflect correct and timely reimbursement. The Account Representative analyzes insurance payments for compliance with managed care contracts and state and federal regulations, resolves underpayments or denials, distributes billing and correspondence appropriately, and provides professional support to patients and internal departments.

Requirements

Ability to multi-task, prioritize needs to meet required timelines
High School Graduate or GED Equivalent Required
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