Patient Accounts Representative

Saint Luke's Health System•Kansas City, MO

About The Position

The Patient Accounts Representative reviews and audits billing charges and handles billing, collections, straightforward coding, and accounts receivable activities for physician clinics within Saint Luke's Health System. The role includes entering charge demographics; troubleshooting charge-related issues raised by clinic staff; handling inbound and outbound patient billing calls; posting payments; resolving payment credits; identifying and correcting medical claim errors that could prevent payment; and correcting and resubmitting claims denied by insurance companies. The representative resolves claim edits, works denials and appeals, and evaluates and codes ICD, CPT, and HCPCS. The role also involves coding initiatives and applying NCCI edits, incidental and inclusive rules, bundling rules, and related requirements, including competency in invalid diagnoses, modifiers, and other coding-related issues. For claim edits, the representative researches patient billing claims and insurance coverage, corrects coding and claim errors, resubmits claims to address coverage denials, and determines documentation needed by payors. The role includes working with 277 EDI transactions and rejections, correcting and distributing payments, entering or correcting charges, coordinating with multiple teams and departments, identifying problem trends, communicating with payors, and coordinating payment plans or financial assistance. For insurance denials and follow-up, the representative researches and corrects denied claims, assesses whether to adjust or void a charge or escalate the matter, writes appeal letters, and follows up on claims without a response. The role also includes handling escalated patient calls about billing-code issues, researching payor refund requests, performing preliminary audits of billing-code errors before submission to the Coding team, routing complex denials, identifying software changes that could prevent denials, learning payor policies, communicating with provider representatives, and performing simple coding such as diagnosis review, modifier application, and certain CPT code changes according to process documents and payor policies.

Requirements

At least 1 year of applicable experience.
Ability to research claims, identify and correct claim or coding errors, and work insurance denials and appeals.
Knowledge of ICD, CPT, and HCPCS coding, including diagnosis review and modifier application.
Familiarity with NCCI edits, incidental and inclusive rules, and bundling rules.
Ability to work with EDI transactions, including 277 EDI transactions and rejections.

Nice To Haves

Billing or coding certifications.

Responsibilities

Review and audit billing charges and perform billing, collections, straightforward coding, and accounts receivable activities for physician clinics.
Enter charge demographics and correct or enter charges.
Troubleshoot charge-related issues raised by clinic staff.
Respond to inbound and outbound patient billing calls, including escalated calls about billing-code issues.
Post payments, resolve payment credits, correct or adjust payment postings, and distribute payments.
Research patient billing claims to identify and correct coding or claim errors.
Research patient insurance coverage and resubmit claims to address coverage denials.
Research and outline documentation needed by payor organizations to process claims correctly.
Work with NCCI edits, incidental and inclusive rules, bundling rules, and related coding requirements.
Identify problem trends and communicate with payors to resolve claim complications.
Handle 277 EDI transactions and rejections, and work with EDI transactions.
Coordinate with multiple teams and departments to resolve issues.
Coordinate payment plans or financial assistance.
Research, identify errors in, and correct claims denied by insurance companies.
Assess claims to determine whether to adjust a charge, void a charge, or escalate the matter to a team lead or another medical billing team.
Write appeal letters to insurance companies and follow up on claims with no response.
Research refund requests from payor organizations.
Perform preliminary audits of billing-code errors before claims are submitted to the Coding team.
Route complex claim denials to a team lead or the appropriate medical billing team.
Identify issues that could be resolved through programming software to prevent denials.
Become a subject matter expert on payor policies.
Communicate and resolve problems with provider representatives.
Perform simple-level coding, including diagnosis review, modifier applications, and some CPT code changes according to process documents and payor policies.
Evaluate and code ICD, CPT, and HCPCS, and demonstrate competency with invalid diagnoses, modifiers, and coding-related issues.