PATIENT ACCOUNT REP

Location/Department:  Business Center - Business Office 

80/pp 

Job Summary:

Investigates unpaid claims and takes the necessary action to resolve an unpaid balance. Provides necessary documentation to insurance/third party liability carriers per the payer request in a timely manner. Research all denied claims and takes appropriate action to correct, rebill or appeal the claims. Submits secondary, tertiary, and late charge billing on all receivable accounts. Addresses all claim edits/holds/rejections, monitors DNFB and communicates with all departments advising them of issues. Investigates medical necessity and coding rejections, research payer guidelines and addresses corrections with the appropriate departments.

Investigates and resolves all known credit balances. Receives incoming patient calls, addresses/resolves patient questions/concerns. Establishes patient payment agreements, accepts phone payments, posts credit card payments on patient accounts as received. Knowledgeable in federal/state compliance regulations required for accurate and timely billing of insurance and self-pay claims

 Supervisory Responsibilities:  None

Duties/Responsibilities:

• Responsible for inbound phone call coverage from patients for billing inquiries
• Responsible for researching unpaid accounts receivable claims and denials, resolving unpaid claims in a timely manner.
• Verifies validity of encounter discrepancies by obtaining and investigating encounter related information including but not limited to: patient demographics, eobs, insurance carriers, etc.
• Addresses all claim edits, holds & rejections, monitors DNFB & informs the CBO Supervisor and/or the Revenue Cycle Director to advise them of the issues in a timely manner.
• Review and update claim edits & claims corrections
• Ensures claims are transmitted daily
• After primary carrier has paid on the claim, ensure the established secondary claims processing workflow is followed
• Responds to patient inquiries within 24 hours, insurance company requests within 48 hrs.
• Accurately & timely documents any patient account activity within comment section of account.
• Claims on hold for medical necessity reviewed with ancillary department for updated symptoms, complaints, or diagnosis.
• Investigate & process credit balances within 14 days, including refunds, transfers, and/or insurance carrier take backs.
• Review payment plan arrangement option with patients as necessary. Enter contract into patient accounting system once fully executed.
• Provide counseling to patients related to all payment options, including access to financial resources that may be able to assist patients with balances due.
• Stays up to date on payer rules and plan coverage requirements.
• Utilizes payer portals and other tools that are available to assist with timely processing, appeals and claim resolution.
• Meets or exceeds productivity standards on a weekly/monthly basis
• Other assignments as assigned by Director

 Required Skills/Abilities:

• Strong data entry & communication skills
• Must be able to operate a computer & other basic office equipment

Education and Experience:

• 2 years relevant experience or documented education in coding and/or billing
• Minimum high school diploma or equivalent

Physical Requirements:

• Frequent sitting & use of hands
• Occasionally may need to lift up to 25 lbs