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 contractual adjustment determinations. The representative processes insurance claims accurately and on time, resolves account issues using available resources and payer-specific guidelines, and works to meet or exceed production goals.

Requirements

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

Nice To Haves

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

Responsibilities

Review, process, bill, and follow up on claims to third-party payers.
Pursue third-party resources persistently and in a timely manner.
Communicate effectively with payers, guarantors, patients, coworkers, and customers to support timely account resolution and customer service.
Make appropriate determinations for contractual adjustments and research required adjustment information.
Process insurance claims promptly and accurately while meeting performance standards.
Evaluate and resolve accounts using bills, remittances, correspondence, worklists, insurance calls, and other available resources 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 informed of changes.
Maintain current knowledge of HCPC and UB04 coding in accordance with insurance payer guidelines.
Assign appropriate follow-up dates with insurance carriers to help ensure prompt payment.
Update billing and registration systems with demographic or insurance revisions on the day they are received.
Follow up promptly on denied, rejected, and pending claims 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 on accounts in accordance with established guidelines.
Keep account information current by entering notes, documentation, and changes when they occur.
Obtain and provide insurance carriers with account information needed to expedite payment.
Meet or exceed defined production goals.
Contribute to effective working relationships by maintaining a positive and helpful attitude toward coworkers and customers.
Perform other duties as assigned.