Patient Account Representative - Medicare, Medicaid, Commercial Claims

Job Family:

Patient Account Representative

Travel Required:

None

Clearance Required:

None

What You Will Do:
 

The Insurance Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client policies and procedures are followed. Representatives will perform any and all job-related duties as assigned.

Essential Job Functions

• Facilitates the billing and collection processes of outstanding accounts receivable

• Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts

• Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns

• Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers

• Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file

• Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated

• Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate

• Performs follow-up processes on accounts to work towards a zero balance

• Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim

• Performs balance transfers

• UB-04 & CMS 1500

• Complete all business-related requests and correspondence from patients and insurance companies.

• Responsible for working on average 35 Accounts Per Day

• Complete all assigned projects in a timely manner. 

• Assist client and patients in all requested tasks.

• Communicate to Guidehouse management areas of concern or areas of improvement. 

• Research and respond to all patient inquiries received by telephone and mail.

• Update patient demographic information and initiate account adjustments.

• Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

What You Will Need:

• High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED.

• 6 months - 2+ year's experience in office, business, operations, customer service or healthcare field.

What Would Be Nice To Have:

• Previous experience working in insurance portals

• PC skills in a Windows environment.

• Knowledge and utilization of desktop applications to include Word and Excel is essential.

• Ability to initiate and follow through on projects and work independently with minimal supervision

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The annual salary range for this position is $34,000.00-$56,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Cor