Patient Accounting Representative

Patient Accounting Representative Job Summary

• Under indirect supervision, processes insurance claims, reports and billing for compensation of patients and members for medical disability benefits;
• processes applications from medical / life insurance, supplemental benefits and assigned accounts;
• obtains background information;
• makes arrangements to obtain monies owing;
• performs other collection responsibilities as needed;
• abides by state collection and credit regulations;
• interprets and complies with state / federal regulations, laws and guidelines in reference to third party payers;
• processes VRs for billing; maintains current knowledge of Client Health Plan benefits and policies;
• acts as Client representative.

Major Responsibilities / Essential Functions,

• Receives, reviews, and controls requests for medical information, visit records, nurse / doctor notes and other pertinent documents;
• verifies completeness and accuracy;
• ensures efficiency in processing of claims;
• obtains medical charts and other data pertaining to request.
• Audits, abstracts, and summarizes pertinent data from patient medical records, nurse / doctor notes and other documents;
• processes insurance claims and reports in compliance with state / federal regulations, laws, guidelines and Client Health Plan policies;
• obtains physician signature and / or signs as provider representative; prepares service charge letters and invoices referring to fee schedule.
• Performs follow-up with insurance companies, agencies, and / or patients; researches and takes action as required.

Prepares and audits visit records and nurse / doctor notes using various fee schedules; prepares documents (e.g. charges, payments, adjustments) with Charge Description Master codes, required billing coding conventions, and batch totals.

• Communicates and corresponds effectively with insurance carriers, intermediaries, members, doctors, outside providers and patients;
• provides in-service orientation to other departments / personnel; obtains complete and valid information;
• ensures collectability and maximum reimbursement of revenues.
• Maintains familiarity and open communication with state, federal and community agencies
• Only those lawfully authorized to work in the designated country associated with the position will be considered.
• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.