Patient Account Representative
3 days ago
Summary:
The Staff Pad is honored to partner with a non-profit healthcare system in Helena, Montana with superior care and a hometown commitment to be the gold standard for health care in Montana. We are in search of a Patient Account Representative to join their team.
Responsibilities
* Performs pre-billing and billing functions to insure successful outcome of claim submission and payment.
* Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance.
* Collaborates with all Team Members within SPH to insure an accurate and timely billing.
* Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership
* Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals.
* Evaluate partial payments to determine if further reimbursement is valid
* Compose technical denial arguments for reconsideration, including both written and telephonically
* Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
* Escalate exhausted appeal efforts to Leadership
* Submits retro authorization to insurance within insurance carrier guidelines
* Researches and takes necessary action to follow up on unpaid claims using ATB's and/or assigned work lists
* Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse
* Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess
* Use effective documentation standards that support a strong historical record of actions taken on the account
* Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application.
* Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation
* Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports.
* Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference.
* Response to all queries timely to insure Gold Standard Customer Service
* Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations
Qualifications
KNOWLEDGE/EXPERIENCE :
* Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory
* Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory
* Proficient keyboard/ 10 key skills and working knowledge of computers required.
* Good verbal and written communication skills.
* Strong data entry, ten key skills and working knowledge of computer required.
* Exceptional customer service and interpersonal communication skills.
* Proficient in examining documents for accuracy and completeness.
* Ability to multitask and manage time effectively.
* Ability to grasp, retain, and apply new regulations
* Mathematical, organization skill and business correspondence skills.
* Basic knowledge in downloading/creating spreadsheets in Microsoft Excel
EDUCATION : High School diploma or GED required. Completes Patient Financial Services I training within first 5 month
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