Patient Accounts Representative

Overview

Patient Accounts Representative (Healthcare)

Make a difference every day at Amoskeag Health, where we believe strong healthcare begins with strong human connections!

Who You Are: Amoskeag Health is seeking a dedicated Patient Account Representative who plays a key role in supporting the revenue cycle process. You are detail-oriented, committed to revenue integrity and accurate reimbursement. In this role, you support the Billing Office by ensuring timely and accurate billing and follow-up on accounts, addressing insurance denials, and documenting account activity thoroughly. You bring strong verbal and written communication skills and are comfortable responding to provider and patient inquiries while maintaining accuracy, organization, and professionalism in a fast-paced healthcare environment.

• Ensure that all claims are reviewed daily and submitted electronically in a timely manner using the claims management system.
• Review all claim edits/claim rejections and make the necessary corrections ensuring compliance with all federal, state and specific commercial payer requirements.
• Work claims in an on-hold status to ensure timely billing practices.
• Coordinate data requests with other departments in support of timely billing (Medical Records/Intake/Provider Orders or Referral Center/Quality Review).
• Utilize resources available to monitor outstanding claims for assigned payers (Work Queues/Aging Reports) and ensure claim follow-up does not exceed payer filing limits.
• Initiate re-billings, corrected claims and appeals following payer requirements.
• Document billing activities on the patient account to assist in problem resolution within the present system used by Amoskeag Billing Office.
• Identify compliance risk and proactively recognize and rectify any issues to prevent payer audits.
• Use in-depth knowledge of contracts and reimbursement to obtain the proper resolution.
• Monitor assigned work to ensure billing and follow-up activities are maintained at the levels set by management.
• Establish independent follow-up processes on accounts worked to ensure payer response.
• Monitor and identify claim rejections or denials for trends for the assigned payer and report them to management.
• Upon receipt, review and determine the proper disposition of claims with credit balances.
• Responsible for the daily reconciliation of charges, adjustments, and payments.
• Reconcile over payments from Medicare, Medicaid, Blue Cross/Blue Shield, and other third-party payments. Maintain files. Pull copies of paid/processed claims from the file. Follow up on unpaid claims within 45 days.
• Ensure payments posted in the system balance against amounts received/deposited.
• Interact with clients in a positive and professional manner; be sensitive in approach to discussions with clients regarding financial matters.