Patient Account Representative – Medicare/Medicaid Exp
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Job Description
Remote Patient Account Representative managing Medicare/Medicaid hospital billing and collections for Med-Metrix. Following up claims, resolving denials, and ensuring accurate payer reimbursement.
Responsibilities:
- Perform collections, account follow-up, and billing allowance posting for assigned accounts
- Follow up with payers via phone, email, fax, or websites to resolve outstanding claims
- Review and accurately update patient and financial information
- Verify responsible parties and insurance payment information
- Monitor billings for accuracy and correct errors
- Monitor Medicaid/Healthy Options coupons to ensure services are billed within expected timeframes
- Bill hospital services to primary insurers or patients correctly and on time
- Explain hospital payment regulations and maintain knowledge of insurance regulations and hospital contracts
- Identify and report underpayments and denial trends
- Analyze and resolve issues causing payer payment delays and initiate appeals when necessary
- Manipulate Excel spreadsheets and communicate results
- Meet departmental productivity and quality standards
- Maintain confidentiality and comply with HIPAA and information security policies
- Limit access to protected health information to the minimum necessary
- Perform other duties as assigned
Requirements:
- High School Diploma or equivalent required
- Medical Billing and Coding certification preferred, but not required
- Experience in Hospital/Facility billing required
- 2-3 years’ experience in insurance collections, including submitting and following up on claims
- Basic knowledge of healthcare claims processing including ICD-9/10, CPT and HCPC codes, and UB-04
- Ability to use workflow and client host systems such as STAR, SMS, EAGLE and EPIC
- Working knowledge of the insurance follow-up process and healthcare reimbursement methodologies
- Understanding of government, Medicare and Medicaid claims
- Basic math and typing skills
- Proficiency with Microsoft Office Suite
- Strong interpersonal, written, and verbal communication skills
- Strong problem-solving and creative skills; ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability, with a strong sense of urgency and results orientation
- Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
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