Medicare/Medicaid - Patient Account Representative

About the role

The Patient Account Representative is responsible for collections, account follow-up, and billing allowance posting for the accounts assigned to them.

Responsibilities

• Follow up with payers to ensure timely resolution of all outstanding claims via phone, email, fax, or websites
• Review and update all patient and financial information accurately as given
• Verify that information is accurate as to the individual or insurance company responsible for payment of the bill
• Monitor all billings for accuracy, updating any errors
• Monitor Medicaid/Healthy Options coupons to ensure services are billed within expected timeframes
• Bill all hospital services to the primary insurer or patient correctly and within the expected timeframe
• Follow up with insurance companies on all assigned accounts within the expected timeframe
• Explain hospital regulations with regard to methods for payment of accounts and maintain a complete working knowledge of insurance regulations and hospital insurance contracts
• Identify and report underpayments and denial trends
• Analyze, identify, and resolve issues causing payer payment delays; initiate appeals when necessary
• Manipulate Excel spreadsheets and communicate results
• Meet and maintain daily productivity and quality standards established in departmental policies
• Act professionally, cooperatively, and courteously with patients, insurance payors, co-workers, management, and clients
• Maintain confidentiality at all times
• Use, protect, and disclose patients’ protected health information (PHI) only in accordance with HIPAA standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum necessary to perform assigned duties

Qualifications

• High School Diploma or equivalent required
• Medical Billing and Coding certification preferred, but not required
• Experience in Hospital/Facility billing required
• 2–3 years’ experience in insurance collections, including submitting and following up on claims
• Basic knowledge of healthcare claims processing including: ICD-9/10, CPT and HCPC codes, as well as UB-04
• Ability to use various workflow systems and client host systems such as STAR, SMS, EAGLE, and EPIC, as well as other tools available to collect payments and resolve accounts
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Understanding of government, Medicare, and Medicaid claims
• Basic math and typing skills
• Proficiency with Microsoft Office Suite
• Strong interpersonal skills; ability to communicate well at all levels of the organization
• Strong problem-solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results-oriented approach
• Excellent written and verbal communication skills required

Working Conditions

• Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
• Physical demands: occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computers, peripherals, and telephones; extend arms; kneel; talk and hear
• Mental demands: ability to follow directions, collaborate with others, and handle stress
• Work environment: noise level in the work environment is usually minimal