Patient Account Representative

About the Role

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. Verify responsible parties for payment, monitor billings for accuracy, and ensure services are billed within expected timeframes. Follow up with insurance companies on assigned accounts, explain hospital regulations regarding payment methods, and maintain knowledge of insurance regulations and contracts.

Responsibilities

• Bill all hospital services to primary insurer or patient correctly and within expected timeframe
• 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 in accordance with HIPAA standards
• Use, protect, and disclose patients' protected health information (PHI) only as necessary to perform assigned duties
• Understand and comply with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the absolute minimum required to perform duties
• Perform other duties as assigned

Requirements

• High School Diploma or equivalent required
• Medical Billing and Coding Certification preferred but not required
• Experience in hospital/facility billing required
• 2-3 years of experience in insurance collections, including submitting and following up on claims
• Basic knowledge of healthcare claims processing including ICD-9/10, CPT, HCPC codes, and UB-04
• Ability to use workflow systems and client host systems such as STAR, SMS, EAGLE, and EPIC
• Working knowledge of the insurance follow-up process and healthcare reimbursement methodologies
• Understanding of government, Medicare, and Medicaid claims
• Proficiency with Microsoft Office Suite, including Excel and Word
• Basic math and typing skills
• Strong interpersonal, problem-solving, and creative skills
• High level of integrity, dependability, and a strong sense of urgency
• Excellent written and verbal communication skills
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
• Occasionally required to move around the work area, sit, perform manual tasks, operate office equipment, extend arms, kneel, talk, and hear
• The employee must be able to follow directions, collaborate with others, and handle stress
• The noise level in the work environment is usually minimal