Patient Account Representative - Hospital experience

Med Metrix•Reading, PA

8d•Onsite

About The Position

The Patient Account Representative is responsible for collections, account follow up, and billing allowance posting for assigned accounts. This role involves ensuring timely resolution of outstanding claims by following up with payers via various communication channels, accurately updating patient and financial information, and monitoring billings for accuracy. The representative will also manage Medicaid/healthy options coupons, correctly bill hospital services, and follow up with insurance companies. Key responsibilities include identifying and reporting underpayments and denial trends, resolving issues causing payment delays, initiating appeals, manipulating Excel spreadsheets, and meeting daily productivity and quality standards. The role requires professional conduct, maintaining confidentiality, and adhering to HIPAA standards for patient information.

Requirements

High School Diploma or equivalent required
Experience in Hospital/Facility billing required
2-3 years’ experience in insurance collections, including submitting and following up on claims
Basic knowledge of healthcare claims processing including: ICD-9/10, CPT and HCPC codes, as well as UB-04
Ability to use various workflow system and client host system such as STAR, SMS, EAGLE and EPIC, as well as other tools available to them to collect payments and resolve accounts
Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
Understanding of government, Medicare and Medicaid claims
Basic math and typing skills
Proficiency with Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required

Nice To Haves

Medical Billing and Coding certification preferred, but not required

Responsibilities

Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
Review and updates all patient and financial information accurately as given
Verify that information is accurate as to individual or insurance company responsible for payment of bill
Monitor all billings for accuracy, updating any errors
Monitor Medicaid/healthy options coupons to assure services are billed within expected timeframes
Bill all hospital services to primary insurer or patient correctly and within expected timeframe
Follow up with insurance companies on all assigned accounts within expected timeframe
Explain hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts
Identify and report underpayments and denial trends
Analyze, identify and resolve issues causing payer payment delays; Initiate appeals when necessary
Manipulate excel spreadsheets and communicate results
Meet and maintain daily productivity and quality standards established in departmental policies
Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients
Maintain confidentiality at all times
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Other duties as assigned