Patient Accounting Representative I (Billing)

Day (United States of America)

Patient Accounting Representative I (Billing)

Review, process, bill, and follow up on claims to third-party payers. Pursue third-party resources in a persistent and timely manner. Effectively communicate with payers/guarantors for timely resolution of accounts. Make appropriate determinations for contractual adjustments.

Job Qualifications

Minimum high school graduate or equivalent required. Associate or bachelor’s degree or relevant certification from an accredited institution preferred.  Requires a minimum of one-year previous experience in healthcare, preferably in hospital billing. Must have knowledge of third-party billing and collections process.  Prefer experience in claim processing and UB-04 claim form requirements.  Must have general computer operations experience.

Job Duties and Responsibilities

• Process insurance claims in a prompt and accurate manner, meeting all corresponding performance standards.
• Demonstrates the ability to evaluate and resolve accounts by utilizing resources including, but not limited to, bills, remittances, correspondence, worklist, and insurance calls in accordance to payer-specific guidelines in a timely manner.
• Corrects and processes rejected and hardcopy claims in a timely manner.
• Demonstrates proficiency in the billing systems and accounts receivable systems, keeping abreast of all changes.
• Maintains current knowledge of HCPC and UB04 coding in accordance with specific insurance payer guidelines.
• Assigns an appropriate date to follow up with the insurance carrier to ensure prompt payment.
• Updates billing and registration systems with any demographic/insurance revisions the same day received.
• Follow up on all denied, rejected, and/or pending claims in a timely manner, utilizing all electronic means available.
• Maintains ability to bill specialty accounts which include, but are not limited to, cycle bills, audit bills, split bills, DME, carve-outs, in-house denials, SDS, etc.
• Analyze and follow up on any late charges credited or debited on accounts in accordance with established guidelines.
• Ensure account information is current by entering notes, documentation, and changes at the time of occurrence.
• Research and determine required adjustment information as deemed necessary in accordance with the insurance payer.
• Obtains and supplies insurance carriers with necessary account information to expedite payment.
• Meets and/or exceeds production goals as defined.
• Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with coworkers and customers.
• Duties as assigned.