Patient Account Representative

The Patient Accounts Representative is responsible to prepare and submits claims to various insurance companies either electronically or by paper. They will need to ensure that all insurance claim edits from Meditech and Cirius are reviewed, analyzed and resolved. Ensure that the claims are compliant with federal and state regulations. Patient Account Representative is responsible for ensuring that all insurance claims are processed and paid.

They will perform all follow up activity on the claim until adjudication. Responsibilities include but are not limited to billing, prompt follow-up and understands the laws that govern the billing.

High School Diploma - Preferred

2-3 Years Medical Accounts or Hospital experience - Preferred

2-3 Years Customer Service experience - Preferred

None Required

• Resolves payer denials promptly and appropriately. Mails paper claims promptly to the proper address. Re-bills accounts when necessary.
• Acts upon computer reminders promptly and appropriately. Uses the most effective follow up method needed. Documents all action taken.
• Files claims as assigned. Follows up on secondary aged accounts according to established time parameters. Resolves reminders promptly.
• Submits assigned claims through Meditech and Billing Clearinghouse and provides confirmation reports to the manager. Reviews the Accounts Receivable Aging Report and works outstanding claims, oldest to newest, making calls to appropriate payor to determine claim status. Works with payor on resolving claim disputes, submits requested paperwork, and notifies Appeals Group for all denials.
• Daily performs billing functions to include but not limited to review and verification of electronic claims, transmission of claims to clearing house, preparation of paper claims as needed, preparation of secondary claims, processing of over payment and underpayment responses and payment posting as assigned. Review treatment authorization status and obtain pre-authorization as needed. Coordinate and review upcoming appointments with operations assistant to assure pre-authorizations for provider visits.
• Seeks answers/assistance from the appropriate source. Keeps up to date on billing/compliance rule changes.

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