The Patient Account Representative is responsible for managing billing processes for assigned insurance carriers and ensures accurate and timely claims submission and follow up. Major functions of this role include billing, accounts receivable maintenance, denial management and collections. The individual in this role must be well versed with payer regulations and federal billing guideline and be experienced with CPT-4 and ICD-9 coding, and medical terminology. They must also possess strong communication and analytical skills and be able to work independently as well as in a team environment.
Performs all duties accurately and timely; including claims submission, follow up, denials management and account reconciliation to maximize financial results.
Always complies with HIPAA guidelines.
Resolves account discrepancies by auditing account detail and cash posting within established timeframe.
Interprets and communicates information regarding billing practices, insurance claims submissions, and out-of-pocket patient responsibility to all customers; including physicians, physicians’ office staff, patients and others with a business need to know.
Serves as a liaison between Patient Accounts and other hospital departments, and always communicates in a clear, helpful and respectful manner.
Oversees the processing of all clerical records and patient information requested to resolve patient account balances.
Works as a collaborative, constructive, cooperative team member within the Patient Accounts department, and assists other office personnel in the performance of their duties as needed to achieve best outcomes.
Follows department policy and procedure to ensure the maintenance of account documentation for audit requirements.
Medical billing experience in a professional setting required either in AR/Follow up, Cash-Ops, denial management or self-pay role
Meditech experience preferred; Experience with Excel, Word and Outlook required
Strong communication and problem resolution skills
Ability to identify billing trends affecting patient balances
Ability to multitask, and ability to follow through with our patients and contacts
Ability to read, understand and interpret insurance Explanation of Benefits
Knowledge of Medicare, Medicaid and other third party insurance billing practices and regulations
Working knowledge of medical terminology, CPT and ICD10 codes
Excellent interpersonal and communication skills, outgoing personality with a professional demeanor and positive attitude
Strong work ethic with exemplary attendance record
Knowledge of HIPAA regulations and patient privacy rules