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Healthcare Account Specialist

2 months ago

Melville, New York, United States Med-Metrix Full time
Job Overview

Position Summary

The Patient Account Representative at Med-Metrix is tasked with managing collections, following up on accounts, and handling hospital correspondence for Workers Compensation and No Fault accounts assigned to them.

Key Responsibilities

  • Utilize various workflow systems and client-hosted platforms such as STAR, SMS, EAGLE, and EPIC to facilitate payment collection and account resolution.
  • Possess a solid understanding of the insurance follow-up process and the fundamental principles of healthcare reimbursement methodologies.
  • Demonstrate knowledge of Workers Compensation and No Fault claims.
  • Engage with payers to ensure prompt resolution of outstanding claims through various communication methods including phone, email, fax, or online platforms.
  • Accurately review and update patient and financial information as provided.
  • Confirm the accuracy of information regarding the individual or insurance company responsible for bill payment.
  • Monitor billing for accuracy and rectify any known discrepancies.
  • Follow up with insurance companies on all assigned accounts within the expected timeframe.
  • Identify and report trends in underpayments and claim denials.
  • Analyze and resolve issues that lead to delays in payer payments and initiate appeals when necessary.
  • Meet and uphold daily productivity and quality standards as outlined in departmental policies.
  • Maintain a professional demeanor while interacting with patients, insurance payors, colleagues, management, and clients.
  • Participate in special projects and additional duties as assigned by management.
  • Ensure confidentiality is maintained at all times.
  • Handle and disclose patients' protected health information (PHI) in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.

Qualifications

  • High School Diploma or equivalent is required.
  • Preferred experience in hospital or facility billing and follow-up.
  • Experience with EPIC is a plus.
  • 2-3 years of experience in insurance collections, including claims submission and follow-up.
  • Basic understanding of healthcare claims processing, including ICD-9/10, CPT, and HCPC codes, as well as UB-04.
  • Able to work effectively both independently and as part of a team.
  • Proficient in Microsoft Office, particularly Excel and Word.
  • Strong organizational, communication, and writing skills.
  • Basic math and typing skills are essential.

Working Conditions

  • Physical Demands: The role may require occasional movement around the work area, sitting, performing manual tasks, and operating office equipment such as computers and telephones.
  • Mental Demands: The employee must be capable of following directions, collaborating with others, and managing stress effectively.
  • Work Environment: The noise level in the workplace is typically minimal.

Med-Metrix is committed to providing equal employment opportunities and does not discriminate against any employee or applicant based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information, political affiliation, military service, veteran status, or any other characteristic protected by federal, state, or local law.