Patient Account Representative - Hospital Medicare experience

Med-Metrix•Reading, PA

About The Position

The Patient Account Representative is responsible for collections, account follow up, and billing allowance posting for assigned accounts. This role specifically requires Medicare/Medicaid experience.

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.
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.

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 update all patient and financial information accurately.
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 the expected timeframe.
Follow up with insurance companies on all assigned accounts within the expected timeframe.
Explain hospital regulations with regard to methods for payment of accounts and maintain a 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.