The Patient Account Representative is responsible for processing 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 should 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 accounts receivable targets. In addition, the incumbent must possess the necessary interpersonal skills needed to provide superior service levels to both internal and external customers. Reviews, corrects as necessary and submits/re-submits medical insurance claims of all types to various governmental programs and private insurance companies through the use of a computerized software platform.
Thoroughly documents in the “notes” section of the patient accounting system any and all actions/occurrences 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 write-off activities, processes late charges, resolves credit balances, files claims appeals, and keeps current on regulatory requirements for all insurance payers. Prepares and submits patient refund forms and resolves credit balances in accordance with hospital policy. 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 Head based on the priorities and needs of the business, as applicable.
High School graduate or equivalent. Minimum of one (1) year claims processing and account follow-up experience in a hospital and/or clinic setting utilizing an electronic claims processing system preferred. Basic knowledge of Federal, State and third party payers claims processing requirements including, but not limited to; determining eligibility, obtaining necessary authorizations, hard copy submissions and various filing periods to ensure timely reimbursements. 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 with benefits offered such as medical, dental, vision, life and disability, paid time off and a 403 b retirement plan.
*COVID-19 Vaccine Required or qualified exemption