Patient Account Representative I - Hospital Biller (Remote)

This is a remote work opportunity 

JOB SUMMARY: The medical billing and Medicare specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare.  In addition, the medical billing and collection specialist must demonstrate proficiency with billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

Examples of Responsibilities:

· Responsible for correcting, completing, and processing claims for all payer codes

· Analyze and interpret that claims are accurately sent to insurance companies

· Perform follow up with Medicare s on unpaid insurance accounts identified through aging reports

· Process appeals online or via paper submission

· Assist with billing audit related information

· Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Team Lead and/or Supervisor.

·       Responsible for working A/R collection opportunities on unpaid claims through provided work queues.

·       Maintains required levels of productivity and quality while managing tasks to ensure timeliness of analytic report resolution.

·       Uses identified and known resources to accomplish collection related tasks, including but not limited to payor websites, provider service lines, analytics and correspondence.

·       Based on aging thresholds, obtains status of claim payment, payment amount and date of payment from insurance company (government or managed). 

·       Works to identify payment resolution when an insurance company does not provide payment information for a claim (this may include steps such as working with billing, coding, cash or other areas to resolve).

·       Based on department processes, responsible for escalating problem claims to management with clear explanation of the problem, if multiple claims are impacted and possible resolution.

·       Responsible for voiding invalid claims through payer portal, uploading to a payor portal or mailing requested documentation (such as medical records or itemized bills), researching payor provider manual or other steps to move claim forward to payment status.

·       Based on department processes, responsible for escalating problem claims to management with clear explanation of the problem, if multiple claims are impacted and possible resolution.

·       Responsible for filing an appeal according to department protocols and guidelines.

·       Responsible for filing reconsideration requests for insurance contractual underpayments.

·       Responsible for reviewing and submitting notification of overpayments (patient or insurance) according to department protocols and guidelines.

·       Participates in A/R clean-up projects or other projects identified.

·       Takes ownership of assignments; other duties as assigned or requested.

·       Communicates and listens effectively with internal and external customers; effectively understands instructions and shares knowledge.

·       Cooperates and interacts with supervisors, peers, other departments, and all customer groups demonstrating our commitment to “service”.

·       Other duties as assigned.

Education and Experience:

·       High School Diploma or GED Equivalent (required)

·       One or more of the following systems or applications:  Epic, SSI, Microsoft Excel and Microsoft Word (preferred)

·       Two (2) years previous hospital and/or physician business office experience (preferred)

Knowledge/Skills/Abilities: 

·       Ability to communicate effectively verbal and written.

·       Ability to work independently.

·       General Accounting and bookkeeping skills.

·       Strong customer service and interpersonal skills.

·       Knowledge of medical billing and medical terminology.