Patient Account Representative
2 weeks ago
We are seeking a highly skilled Patient Account Representative to join our team at North Carolina Specialty Hospital. As a Patient Account Representative, you will play a critical role in ensuring the smooth operation of our medical billing process.
Key Responsibilities- Process daily claims batches and upload them to our claims clearinghouse in a timely manner.
- Resolve daily Waystar claim edit rejections and escalate any unresolved issues to the manager.
- Resolve all 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 the 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 the 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. Placing focus on Inpatient and over 3K high dollar accounts first and then switching 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 ensures 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
- 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.
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. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled. We maintain a drug-free workplace and require pre-employment drug screening and background check.
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