Knoxville Hospital and Clinics strive to be your healthcare destination, building on compassion and innovation. We are committed to faithfully providing exceptional healthcare. The values we hold true are Teamwork, Innovation, Compassion, Integrity, Service, and People-Centered.
This is a Full-Time position working 40 hours a week.
The Patient Account Representative is responsible for processing health insurance claims in accordance with all Federal, State and Local regulations, as well as, adhering to the requirements/guidelines mandated by private insurance payers via the hospital’s contractual agreements. The incumbent must possess a working knowledge of electronic claims processing requirements and all data elements associated with filing UB-04 and CMS 1500 claim forms for reimbursement from governmental and other third-party payers. The incumbent is also responsible for complete, accurate and timely follow-up on patient accounts to ensure compliance with the hospital’s key performance metrics. In addition, the incumbent must possess the necessary interpersonal skills needed to provide superior service levels to both internal and external customers.
Essential Functions
- Reviews, corrects as necessary and submits/re-submits medical insurance claims of all types to various governmental programs and private insurance companies via a computerized software platform (Cerner).
- Thoroughly documents in the “notes” section of the patient accounting system any actions pertaining to activity on assigned patient(s) financial records.
- Completes balance transfers, conducts claims research, offers information/support to other peripheral partners in the department/hospital to assist in resolving questions/issues relating to patient accounts, performs certain limited write-off activities, processes late charges, resolves credit balances, files claim appeals, and keeps current on regulatory requirements for all insurance payers.
- Processes insurance refund forms and resolves credit balances in accordance with hospital policy and various payer guidelines.
- Interacts with representatives of various governmental and private insurance payers via telephone, databases, websites, written correspondence etc. to address/resolve medical claims related issues.
- Actively supports the Customer Service Department in resolving customer queries, complaints and requests when called upon.
- Performs other duties as assigned by the Department Leader or Supervisor based on the priorities and needs of the business, as applicable.
Job Requirements
- REQUIRED – High School graduate or equivalent with some college background preferred.
- REQUIRED – Currently employed as a medical insurance biller with a minimum of four (2) years medical claim processing and account follow-up experience in a hospital and/or clinic setting utilizing an electronic claims processing system.
- REQUIRED – Current working knowledge of Federal, State, and third-party payers claim processing requirements including, but not limited to; determining eligibility, obtaining necessary authorizations, hard copy submissions and various timely filing periods to ensure timely reimbursements.
- A Working knowledge of the Cerner EMR system is preferred
- Must be results-oriented, technically strong with good interpersonal skills, able to listen and follow directions consistently, work independently with minimal supervision, assist fellow team members when called upon, possess good oral and written communication skills in English, be able to multi-task and maintain a high level of accuracy, completeness and timeliness.
- Proficient in the use of a PC and other general office equipment.
- Knowledge of MS Office software, including WORD, EXCEL, and OUTLOOK.
This is a Full-time position and is eligible for benefits for medical, dental, vision, flexible spending accounts, retirement plan with company match of up to 6%, accrued hours for vacation and sick time, paid holidays, and company benefits for employee life, employee AD&D, short term and long-term disability.
