Patient Account Billing and Credit Balance Specialist
2 weeks ago
The Patient Account Representative - Billing and Credit Balance is a critical role in ensuring the accurate and timely resolution of claims and refunds. This position is responsible for billing follow-up and collection on assigned accounts with appropriate payers, including governmental agencies, attorneys, patients, and insurance companies. The ideal candidate will possess strong analytical and quantitative skills, with the ability to work independently and make decisions under deadlines.
Key Responsibilities- Responsible for billing follow-up and collection on assigned accounts with appropriate payers.
- Appropriately respond to billing and credit questions from colleagues, peers, and third-party payers.
- Negotiate with third-party payers and patients to resolve outstanding insurance balances successfully.
- Work with appropriate department/clinic/administrative staff to resolve or facilitate resolution regarding questions and/or issues related to billing, coding, and denials.
- Responsible for the understanding of insurance Coordination of Benefits and medical billing guidelines or laws.
- Perform maintenance as needed on the patient's insurance record to ensure accurate billing.
- Responsible for reading, understanding, and complying with all departmental and job-specific policies and procedures within the Department.
- Responsible for follow-up on account by performing necessary charge void and charge entry actions resulting from inquires or incorrect billings.
- Re-issue claims and statements when necessary and resubmit to appropriate parties.
- Responsible for knowing and understanding benefit structures provided and administered by HealthPartners, its subsidiaries, and insurance companies.
- Identify and propose solutions to problems which contribute to customer dissatisfaction in order to reduce future complaints or errors.
- Assist in orientation for new Patient Accounting staff. Operates as a member of Patient Accounting Team in support of other staff.
- Completes assigned projects and duties in a timely manner.
- Inform management/supervisor of deficiencies and erroneous items or codes in Resolute (billing system) master files.
- Reviews and interprets payer remittances to determine appropriate action to be taken on denied claims, including an understanding of provider level adjustments (PLB).
- Understand and comply with established workflows for corrected claims.
- Submit insurance appeals with supporting documentation when warranted.
- Identify when there is a need to appeal a refund request from a third party payer.
- Compile and submit documentation for refunds due to patient and third-party payers when overpayments are requested or identified.
- Work aged balances per assigned work direction/strategy outlined by management.
- Coordinate with Coding and Billing personnel for correct and timely submission and/or resubmission of claims to third-party payers.
- Post and reconcile both patient and insurance payments posted to set reconciliation methods as defined by management.
- Produce and print demand claims as warranted.
- Compare batch proofs and source documents for accuracy.
- Contact third-party payers to determine proper posting of payments as needed.
- Resolve both undistributed and credit balance accounts while working from assigned worklist.
- Research all aspects of the claim cycle to identify and correct errors which caused misappropriated funds.
- Perform other duties as required to accomplish departmental goals and meet patient needs.
At HealthPartners, we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin.
We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included, and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state, or local protected class.
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