Patient Account Representative

4 weeks ago

Durham, North Carolina, United States North Carolina Specialty Hospital Full time
Job Summary

We are seeking a highly skilled and detail-oriented Medical Billing Specialist to join our team at North Carolina Specialty Hospital. As a key member of our revenue cycle operations, you will be responsible for ensuring accurate and timely billing and reimbursement for our patients.

Key Responsibilities
  • Process daily claims batches and upload to our claims clearinghouse, Waystar, in a timely manner.
  • Resolve daily Waystar claim edit rejections and escalate unresolved issues to manager.
  • Resolve assigned claim rejections and/or returned to provider claim edits from Medicare via eSolutions in a timely manner and escalate to Manager new issues as needed.
  • Process and review daily PRC-EBO, PRC BD placement files and assure balances are placed appropriately to the agency.
  • Process daily Final Letter notices for mailing.
  • Work and find billing resolution for all claims rejecting in the daily Biller Desktop tool in Meditech.
  • Process daily Late Charges in a timely manner.
  • Provide supporting documentation for all approved self-refunds to Barry Howell for final processing.
  • Respond to all attorney requests for billing records in a timely manner.
  • Follow up on FB account status via the monthly period end A/R report by reviewing the listed accounts to determine if the claim has been accepted and processed for payment or denied.
  • Effectively and timely identify the root cause of non-payment denials and work with the insurance company, the patient, and allied healthcare support staff to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered.
  • Appropriately escalate denials via the payer appeals process, and obtain all needed documentation to support the appeal escalation.
  • Contact insurance carriers, patients, or guarantors at established intervals to follow up on status of delinquent accounts, determines the reason of delay, and expedites payment.
  • Respond in a timely and effective manner to all insurance correspondence inquiries received on assigned accounts.
  • Use effective time management skills to prioritize work flows and respond to claim denials in a timely manner.
  • Place focus on inpatient and over 3K high-dollar accounts first and then switch to an all high to low, old to new methodology to ensure the accounts receivables are worked from an all-angle perspective.
  • Appropriately assign the correct status, denial date, appeal deadline date, root cause, comments, and follow-up date to each reviewed account listed on the monthly period end A/R report to help ensure that the correct statistics and follow-up is being assigned to the account.
  • Maintain an average score of 3 or more on the monthly report card evaluations.
  • Work on special projects as assigned and seek team lead guidance to help achieve departmental goals.
  • Provide specific timely feedback to team lead regarding denial trends, system, and payer-specific issues.
  • Help department identify front-end solutions to claim denials geared at improving clean claim submission and decrease denials.
  • Keep up to date of assigned payer regulation changes, notices, and bulletins and ensure all information is shared with team leader, manager, and staff in a timely manner.
  • Attend in-services and seminars to stay abreast of current issues affecting reimbursement, billing, and collections for all payers.
  • Maintain files and documentation of current regulations and guidelines in the shared payer folders.
  • Provide patient-focused customer service to assist patients with questions or problems in a courteous and effective manner.
  • Adhere to all hospital policies and procedures, specifically guidelines for appropriate conduct, corporate compliance, diversity, and confidentiality.
  • Demonstrate the spirit of the philosophy, mission, and values of the hospital through words and actions and implement them into departmental processes, programs, and the working environment.
  • Adhere to confidentiality policy.
  • Maintain positive working relationships and foster cooperative work environment.
  • Adhere to the hospital's 'guidelines for appropriate conduct' in the HR manual.
  • Display honesty and mutual respect when communicating with peers and other departments.
  • Follow through on problems that may compromise effective job performance by using appropriate chain of command: team leader, manager, and CFO.
Requirements
  • Must have functional knowledge of medical terminology.
  • Two (2) to three (3) years' experience in patient accounting preferred.
  • Experience in a healthcare/surgery setting preferred.
  • CPT coding certification preferred.
  • Effective communication skills; both orally and written.
  • Computer skills needed.
  • Strong problem-solving skills.
About Us

North Carolina Specialty Hospital offers a competitive compensation and benefits package and an opportunity to grow and develop your career in an environment that values employee ideas and diversity.

We maintain a drug-free workplace and require pre-employment drug screening and background check.

This description is intended to provide only basic guidelines for meeting job requirements.

Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

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