Patient Account Representative – Medicare, Medicaid, Commercial Claims

Role Overview

• Facilitates the billing and collection processes of outstanding accounts receivable
• Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts
• Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns
• Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers
• Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file
• Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated
• Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate
• Performs follow-up processes on accounts to work towards a zero balance
• Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim
• Performs balance transfers UB-04 & CMS 1500
• Complete all business-related requests and correspondence from patients and insurance companies.
• Responsible for working on average 35 Accounts Per Day
• Complete all assigned projects in a timely manner.
• Assist client and patients in all requested tasks.
• Communicate to Guidehouse management areas of concern or areas of improvement.
• Research and respond to all patient inquiries received by telephone and mail.
• Update patient demographic information and initiate account adjustments.
• Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

Requirements

• High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED
• 0-2+ year's experience in office, business, operations, customer service or healthcare field
• Previous experience working in insurance portals (nice to have)
• PC skills in a Windows environment
• Knowledge and utilization of desktop applications to include Word and Excel is essential
• Ability to initiate and follow through on projects and work independently with minimal supervision

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program