Patient Accounts Representative

Saint Luke's Physician Group•Kansas City, MO

3d•Remote

About The Position

This position is a work from home position with a flexible schedule, Monday through Friday, between 6:00 AM and 6:00 PM. The role involves researching patient billing claims and insurance coverage to identify and correct errors, leading to the resubmission of claims and resolution of coverage denials. Responsibilities include understanding NCCI edits, incidentals/inclusive, and bundling rules, identifying problem trends, communicating with payors, and working with EDI transactions. The role also requires handling payment posting corrections/adjustments, charge corrections/entries, and coordinating with multiple teams. Additionally, the position involves managing insurance denials and follow-up, including correcting claims, making charge adjustments, voiding charges, writing appeal letters, following up on claims with no response, and handling patient calls escalated from customer service regarding billing code issues. The representative will also research refund requests, perform preliminary audits of billing code errors, route complex claim denials, identify issues for software programming to prevent denials, become a subject matter expert on payor policies, communicate with provider representatives, and perform simple level coding including diagnosis review, modifier applications, and some CPT code changes.

Requirements

2 years applicable experience
Diploma
Must live in or around the Kansas City metropolitan area.

Nice To Haves

Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc.

Responsibilities

Researching patient billing claims to identify and correct coding/claim errors.
Researching patient insurance coverage to identify and resubmit claims to fix coverage denials.
Researching and outlining documentation needed for respective payor organizations so that claims are processed correctly.
Identifying problem trends.
Communicating with payors for resolution to complications with claims.
Handling 277 EDI transactions/rejections.
Working with EDI transactions.
Performing payment posting corrections/adjustments and ability to distribute payments.
Correcting/entering charges.
Working with multiple teams/departments to resolve issues.
Coordinating payment plans or financial assistance.
Researching, identifying errors, and correcting claims denied by insurance companies.
Assessing claims to determine when appropriate to make charge adjustments, void a charge, or escalate to the team lead and/or another medical billing team.
Writing appeal letters to insurance companies.
Following up with insurance companies for no response claims.
Working with patient calls escalated from the Customer Service team regarding billing code issues.
Researching refund requests from payor organizations.
Performing preliminary audits of billing code errors before claim submitted to the Coding team.
Routing complex claim denials to the team lead and/or the appropriate medical billing team.
Identifying issues which can be resolved by programming software to prevent denials.
Becoming a subject matter expert on payor policies.
Communicating and resolving problems with provider representatives.
Performing simple level coding, including diagnosis review, modifier applications, some CPT code changes following process documents and payor policies.