Pt. Receivable Rep-Denials

Job Description

Full Time - Day Shift

The Patient Receivable Rep. - Denials position processes and follows up on all nongovernment denials, correspondence and appeals for TSH until paid in full. Handles inquiries from patients, third parties and agencies regarding any aspect of services received or status of account. Reviews and completes follow through on remittances for allowances and rejections. Updates receivable system with any new, corrected or pertinent information in relation to resolution of receivable accounts. Stay current with all tasking functions. It is imperative that all care that is provided to the patient is accurately reflected on the bill and is in compliance with regulations pertaining to facility billing and patient care. It is imperative that we actively work in the AR to ensure that we are reimbursed appropriately for the services rendered and to ensure that we don't receive erroneous denials. The staff ensures that the accounts are paid accurately as well as reviews the aged AR to make sure all revenue is captured, and the patients are not erroneously held liable for charges.

Responsibilities -

1. Ensure prompt, accurate, and compliant billing and payments for all third-party payer patient claims. 2. Accurate billing and/or follow-up of patient accounts according to established departmental guidelines based upon regulation requirements for specific insurance carriers. 3. Monitors and reconciles daily reports as well as assigned worklist for appropriate account resolution inclusive to credit, debit and adjustments. 4. Documentation of all action taken on an account. 5. Completes all projects as assigned. 6. Maintains department standards of productivity. 7. Accurate analysis of denials and contracts to recover underpayments/resolve outstanding accounts receivable. 8. Analyze all accounts and contacts appropriate party of unpaid accounts and updates all accounts appropriately. 9. Facilitates patients' and departments in the health system by providing excellent customer service skills and serving as an advocate for the patient in explaining third party payer coverage's, referral and pre-certification requirements. 10. Providing timely and accurate information regarding patient data/status to other health system departments, physicians, physician office staffs and other publics while ensuring patient confidentiality is not breached. 11. Performs other related duties as assigned or requested to maintain a high level of service. 12. Demonstrates professional work behavior by following Service Standards and Success factors. 13. Trends denials/issues by payer to present to management during team meetings.

Education/Work Requirements -

Two years college, and/or three years prior equivalent experience in a hospital setting with experience in revenue cycle. Computer literacy in PC environment is required with strong organizational, analytical, interpersonal and communication skills. Familiar with hospital billing and coding.

Job Info

Job Identification: 3739

Job Category: 020 - Clerical

Posting Date: 2025-03-05T17:23:35 00:00

Job Schedule: Full time

Locations: 3001 Summer St. Stamford CT 06905 US

Regular or Temporary: NA