Patient Account Representative - Medicare, Medicaid, Commercial Claims

Guidehouse•Lewisville, TX

2d•$34,000 - $56,000

About The Position

The Insurance Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client policies and procedures are followed. Representatives will perform any and all job-related duties as assigned. Specific Duties for This Role: General knowledge and understanding of back end RCM functions Navigating payer portals when statusing claims Identifying denials Understanding the difference between government and commercial payers Understanding network payers Essential Job Functions: Facilitates the billing and collection processes of outstanding accounts receivable Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate Performs follow-up processes on accounts to work towards a zero balance Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim Performs balance transfers UB-04 & CMS 1500 Complete all business-related requests and correspondence from patients and insurance companies. Responsible for working on average 35 Accounts Per Day Complete all assigned projects in a timely manner. Assist client and patients in all requested tasks. Communicate to Guidehouse management areas of concern or areas of improvement. Research and respond to all patient inquiries received by telephone and mail. Update patient demographic information and initiate account adjustments. Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

Requirements

High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED.
6 months - 2+ year's experience in office, business, operations, customer service or healthcare field.

Nice To Haves

Previous experience working in insurance portals
PC skills in a Windows environment.
Knowledge and utilization of desktop applications to include Word and Excel is essential.
Ability to initiate and follow through on projects and work independently with minimal supervision

Responsibilities

Facilitates the billing and collection processes of outstanding accounts receivable
Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts
Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns
Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers
Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file
Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated
Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate
Performs follow-up processes on accounts to work towards a zero balance
Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim
Performs balance transfers UB-04 & CMS 1500
Complete all business-related requests and correspondence from patients and insurance companies.
Responsible for working on average 35 Accounts Per Day
Complete all assigned projects in a timely manner.
Assist client and patients in all requested tasks.
Communicate to Guidehouse management areas of concern or areas of improvement.
Research and respond to all patient inquiries received by telephone and mail.
Update patient demographic information and initiate account adjustments.
Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program