About this role
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