Patient Account Representative

POSITION DESCRIPTION

Responsible for contacting payers to collect insurance payments and resolve denied claims by initiating claims appeals and following escalation protocols. This is a non-exempt, hourly position.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Follows up and reports the status of insurance accounts for assigned payers, adhering to the Collection Queue Priority Matrix. Documents each collection action with clear notes including current claim status, denial reasons, actions taken, and follow-up dates.
• Performs various insurance collection activities including contacting payers, coordinating with the Medical Billers to correct and resubmit claims, and submitting medical records upon request.
• Prepares and files claim reconsiderations and appeals.
• Attends meetings with insurance provider relation representatives. Foster a professional relationship with designated representatives and escalate appropriate claims for resolution.
• Reviews and corrects rejected electronic claims in Payerpath clearinghouse.
• Submits secondary claims with the primary insurance Explanation of Benefits and medical records.
• Identifies and reports denial and error trends through preparation and analysis of payer-specific or other A/R analytical reports. Reports denial trends to the team through weekly meetings to discuss resolutions.
• Collaborates with the Patient Financial Counselors and other departments to investigate and request reprocessing for claim and payment processing errors.
• Submits Write-off and adjustment requests (WARs).
• Investigates and submits Refund Requests for insurance overpayments. Submits appeals to payers disputing refund if appropriate (RR).
• Maintains the strictest confidentiality; and adheres to all HIPAA guidelines/regulations.
• Prepares payer-specific or other claim denial analytic reports as directed by supervisor.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES: None.

REQUIRED EDUCATION AND EXPERIENCE:

• Associate degree or two (2) years of experience in insurance collections with a high school diploma or GED.
• Previous work-related skill, knowledge, or experience.

PREFERRED EDUCATION AND EXPERIENCE:

• Insurance collection experience in oncology, hematology, orthopedics, and Rheumatology.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Excellent organization and time management skills along with excellent verbal and written communication skills.
• Familiarity with Microsoft applications (including, but not limited to Word and Excel).
• Knowledge of medical billing/collection practices.
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Understanding of medical terminology and insurance laws/guidelines.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to walk or stand.
• Frequently required to utilize hand and finger dexterity.

LANGUAGE SKILLS: English