Job Description

The Patient Account Rep is responsible for revenue cycle processes for professional billing. This includes but is not limited to data entry, charge processing, claims management, claim edit, claim denials, patient and insurance refunds, and A/R (Accounts Receivable) follow-up processes.

Core Competencies

• Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
• Confirms all pre-bill edits have been cleared, and all required signatures have been obtained prior to billing.
• Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
• Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
• Tracks and reports the status of claims denied and in the appeal process, including both payments and adjustments.
• Promotes positive customer relations.
• Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient.
• Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
• Assists with orientation and training of new employees/ volunteers, as assigned.
• Attends meetings and seminars with insurance plans, medical groups and IPA’s.
• Completes appropriate forms as requested by the department.
• Demonstrates expertise in all aspects of Insurance billing functions.
• Documents detailed notes including action items taken, when appropriate.
• Documents detailed notes to all incoming correspondence and inquiries from payers, patients and other departments.
• Elevates issues as appropriate to Manager..
• Identifies and resolves payer issues and patient billing complaints
• Follows up with appropriate personnel and insurance agencies, etc to advise and resolve problem issues, and inform Manager of outcome.
• Issues appropriate denial letter and mails within specified timeframe.
• Performs collection actions including contacting patient, insurance companies, or third party payers.
• Prepares and submits write off requests to Manager for denied claims that cannot be appealed.
• Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
• Reviews explanation of benefits to resolve accounts.
• Reviews claim scrubber and resolves claim edits..
• Accesses computer system(s) for retrieval of patient information.
• Reviews patient account with credit balances. Makes corrections, if needed and or submits refund request when appropriate.

Department Specific Competencies

• Adheres to productivity standards established per area.
• Answers the telephone courteously within three rings, identifying self and department, routes calls, ascertains needs and takes accurate messages as appropriate.

Additional Information

Experience

Number of Years ExperienceType of Experience3Physician billing

Additional Information

1. A minimum of 3 years' experience in physician billing required.
2. Knowledge of ICD-10, CPT, HCPCS and LCD/NCD coding including ensuring compliance to accepted guidelines

Compensation Range

$25.00 - $34.02 / Hour