Patient Accounting Representative - Claims Processor

Halifax Health•Daytona Beach, FL

About The Position

The Patient Accounting Representative - Claims Processor reviews, processes, bills, and follows up on claims to third-party payers. The role pursues third-party resources persistently and promptly, communicates effectively with payers and guarantors to resolve accounts, and makes appropriate determinations for contractual adjustments. The representative processes insurance claims accurately and on time, resolves accounts using available billing and payment resources and payer-specific guidelines, and follows up on denied, rejected, pending, or late-payment accounts. The position also maintains accurate billing and registration records, supports specialty billing, and meets or exceeds production goals. Additional duties may be assigned.

Requirements

High school diploma or equivalent required.
At least two years of experience in healthcare billing and/or a business office setting; hospital billing is preferred.
Ability to communicate effectively with patients while maintaining customer service expectations.
General PC knowledge in a business setting required.
Good oral and written communication skills.

Nice To Haves

Associate or bachelor's degree from an accredited institution preferred.
Experience with Meditech, Epic, and/or EMR systems preferred.
Hospital billing experience preferred.

Responsibilities

Review, process, bill, and follow up on claims to third-party payers.
Pursue third-party resources persistently and in a timely manner.
Communicate with payers and guarantors to resolve accounts promptly while meeting customer service expectations.
Make appropriate determinations for contractual adjustments.
Process insurance claims promptly and accurately, meeting applicable performance standards.
Evaluate and resolve accounts using resources such as bills, remittances, correspondence, worklists, and insurance calls, in accordance with payer-specific guidelines.
Correct and process rejected and hardcopy claims in a timely manner.
Maintain proficiency in billing and accounts receivable systems and stay current with changes.
Maintain current knowledge of HCPC and UB04 coding in accordance with insurance payer guidelines.
Assign appropriate follow-up dates with insurance carriers to ensure prompt payment.
Update billing and registration systems with demographic or insurance revisions on the same day they are received.
Follow up on denied, rejected, and pending claims in a timely manner using available electronic means.
Bill specialty accounts, including cycle bills, audit bills, split bills, DME, carve-outs, in-house denials, and SDS.
Analyze and follow up on late charges credited or debited to accounts according to established guidelines.
Keep account information current by entering notes, documentation, and changes when they occur.
Research and determine required adjustment information as necessary in accordance with insurance payer requirements.
Obtain and provide insurance carriers with account information needed to expedite payment.
Meet or exceed defined production goals.
Contribute to effective working relationships by demonstrating a positive and helpful attitude with coworkers and customers.
Perform other duties as assigned.