Patient Account Representative 2

University of Washington•Seattle, WA

1d•Onsite

About The Position

UW Medicine’s Patient Financial Services has an outstanding opportunity for a Patient Account Representative 2. This role involves editing, preparing, and submitting various billing forms and electronic claims, analyzing and resolving unresolved insurance accounts, and performing follow-up on insurance claims and accounts. The position requires reviewing and analyzing payer denials, managing accounts receivable adjustments, and analyzing credit-balance accounts. Additionally, the role involves updating patient information, communicating with staff and payers, and maintaining tracking tools. The Patient Account Representative 2 will utilize available systems, payer portals, and other resources to verify information and resolve accounts.

Requirements

High School graduation or equivalent
Two years of experience in patient accounting, customer service, or a related office environment
Equivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.

Nice To Haves

Knowledge of UB, CMS 1500, ADA and other utilized billing forms and payer requirements.
Knowledge of Epic Hospital Billing and/or SBO (a combination of hospital and professional) billing, and registration systems.
Related office environments include Hospital or SBO: patient financial services, insurance billing, claims processing and follow-up, claims denials, appeals, underpayments or other business office settings involving patient account insurance billing and follow-up functions.

Responsibilities

Edit, prepare, and submit UB-04, CMS-1500, ADA, and other applicable billing forms and electronic claims in accordance with regulatory requirements
Analyze and take appropriate action on unresolved insurance accounts, including denied, rejected, unpaid, underpaid, suspended, or otherwise unresolved claims
Perform insurance claim and account follow-up by researching claim status, payer processing requirements, eligibility, benefits, authorizations, medical necessity requirements, payment discrepancies
Review and analyze payer denials and claim rejections to determine the appropriate corrective action, including claim correction, rebilling, reconsideration, appeal, adjustment, or other payer follow-up necessary to resolve the account
Review the status of the entire patient account and exercise independent judgment to determine the appropriate course of action for resolution, considering claim history, payer responses, payments, adjustments, outstanding balances
Prepare and/or process Accounts Receivable adjustments in accordance with departmental policies, payer requirements, contractual terms, and established adjustment guidelines
Analyze insurance credit-balance accounts to determine the cause of the credit balance and take appropriate action to resolve payer overpayments, duplicate payments, payment posting discrepancies
Utilize available systems, payer portals, internal resources, and other reference materials to obtain and verify insurance eligibility, benefits, coverage, authorization, claim status, payment
Update patient demographic, insurance, and payer information in applicable systems to support accurate claim submission, payer processing, reimbursement, and account resolution
Communicate effectively with Medical Center staff and third-party payers as required to obtain, verify, and resolve billing, claim, eligibility, authorization, payment, and reimbursement information
Maintain spreadsheets, reports, and other tracking tools to support account follow-up, workload management, payer activity, reimbursement analysis, and departmental reporting; utilize Microsoft Excel, Word, and other applicable software to prepare correspondence and documentation