Patient Account Rep

Core Competencies

• Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
  
  
• Confirms all pre-bill edits have been cleared, and all required signatures have been obtained prior to billing.
  
  
• Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
  
  
• Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
  
  
• Tracks and reports the status of claims denied and in the appeal process, including both payments and adjustments.
  
  
• Promotes positive customer relations.
  
  
• Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient.
  
  
• Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
  
  
• Assists with orientation and training of new employees/ volunteers, as assigned.
  
  
• Attends meetings and seminars with insurance plans, medical groups and IPA’s.
  
  
• Completes appropriate forms as requested by the department.
  
  
• Demonstrates expertise in all aspects of Insurance billing functions.
  
  
• Documents detailed notes including action items taken, when appropriate.
  
  
• Documents detailed notes to all incoming correspondence and inquiries from payers, patients and other departments.
  
  
• Elevates issues as appropriate to Manager..
  
  
• Identifies and resolves payer issues and patient billing complaints
  
  
• Follows up with appropriate personnel and insurance agencies, etc to advise and resolve problem issues, and inform Manager of outcome.
  
  
• Issues appropriate denial letter and mails within specified timeframe.
  
  
• Performs collection actions including contacting patient, insurance companies, or third party payers.
  
  
• Prepares and submits write off requests to Manager for denied claims that cannot be appealed.
  
  
• Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
  
  
• Reviews explanation of benefits to resolve accounts.
  
  
• Reviews claim scrubber and resolves claim edits..
  
  
• Accesses computer system(s) for retrieval of patient information.
  
  
• Reviews patient account with credit balances. Makes corrections, if needed and or submits refund request when appropriate.
  
  

Department Specific Competencies

• Adheres to productivity standards established per area.
  
  
• Answers the telephone courteously within three rings, identifying self and department, routes calls, ascertains needs and takes accurate messages as appropriate.
  
  

Experience

1. A minimum of 3 years' experience in physician billing required.
2. Knowledge of ICD-10, CPT, HCPCS and LCD/NCD coding including ensuring compliance to accepted guidelines

Compensation Range
$25.00 - $34.02 / Hour