Patient Accounting Representative - Claims Processor

Day (United States of America)

Patient Accounting Representative - Claims Processor

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.

- Minimum high school graduate or equivalent required. Associates or Bachelor’s degree from accredited institution is preferred.
- Minimum of two years experience in healthcare billing and/or business office setting, preferably in hospital billing.
- Must be able to communicate with patients effectively while maintaining customer service expectations.
- Preferred experience in Meditech, Epic and/or EMR systems.
- General PC knowledge in business setting is required.
- Must have good oral and written communication skills.

· 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 appropriate dates to follow up with insurance carrier to ensure prompt payment.

· Updates billing and registration systems with any demographic/insurance revisions the same day received.

· Follows 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 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 time of occurrence.

·Research and determines required adjustment information as deemed necessary in accordance with 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