Patient Accounts Representative

Advanced Urology Center•Snellville, GA

About The Position

Reviews claims to ensure payer-specific billing requirements are met by utilizing payer websites, payer payment and medical policies for insurance follow-up to improve cash collection efforts. Reviews denials for trends and helps identify root causes. Works with coding and leadership to draft appeals using all available resources and follows the denial through all appeal levels as needed. The responsibilities also include and are not limited to following-up on claim processing to reconcile patient accounts using all available resources such as payer portals, EOB’s and applying adjustments as needed. Accurately updates patient accounts as necessary, and being a reliable partner within our team to provide an exceptional billing and collections service that enhances the patient experience.

Requirements

High School Diploma or GED
4+ years of experience in healthcare-related field or setting
Working knowledge of Medicare, Medicaid, and other contract payers (HMO, PPO)

Nice To Haves

5+ years of experience in healthcare related setting.
Previous experience in Clinic, ASC or Hospital setting.
Experience in medical billing, accounts receivable, or collections.
Knowledge of medical terminology, insurance billing procedures, and healthcare reimbursement mechanisms.
Working knowledge of E-clinical Works
Working knowledge of payor portals and Availity.
Working knowledge of Clearinghouse system.
Strong negotiation and problem-solving skills to resolve billing discrepancies.
Ability to work independently, prioritize tasks, and meet collection targets.
Certified Patient Account Representative (CPAR)

Responsibilities

Reviews claims to make sure that payer specific billing requirements are met by utilizing payer websites, payer payment and medical policies for insurance follow-up to improve cash collection efforts.
Review denials for trends and help identify root causes.
Work with coding and leadership to draft appeals using all available resources and follow the denial through all appeal levels as needed.
Following-up on claim processing to reconcile patient accounts using all available resources such as payer portals, EOB’s and applying adjustments as needed.
Accurately update patient accounts as necessary.
Provide an exceptional billing and collections service that enhances the patient experience.
Effectively navigate through complex information in regard to current contracts insurance/payer medical policies, individual plan type details, referrals, authorizations, and account follow-up in a timely manner.
Respond effectively to the reactions and positions of patients and payers to recommend adjustments and bring timely resolution to accounts.
Coordinate activity with the collections team to ensure timely, accurate rebill of accounts, while facilitating quality improvement through reporting opportunities for increased revenue and decreased denials.
Maintain up to date knowledge regarding government and commercial payors status and their insurance products, associated Explanation of Benefits (EOB), and other information related to accounts receivable follow-up.
Ensure maximum entitled reimbursement and apply review appropriate allowances and adjustments by clearing balances on accounts and pursuing billing of secondary insurance or patients.