Patient Account Representative, Medicare/Medicaid
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Job Description
Patient Account Representative managing hospital Medicare/Medicaid billing and insurance collections for Med-Metrix. Following up claims, resolving denials, posting allowances, and maintaining HIPAA compliance.
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 the individual or insurance company responsible for payment
- Monitor billings for accuracy and correct errors
- Monitor Medicaid/Healthy Options coupons to ensure services are billed within expected timeframes
- Bill hospital services correctly and timely to primary insurers or patients
- 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; initiate appeals when necessary
- Manipulate Excel spreadsheets and communicate results
- Meet departmental daily productivity and quality standards
- Interact professionally with patients, insurance payors, coworkers, management, and clients
- Maintain confidentiality and handle protected health information according to HIPAA and information security policies
- Limit PHI access 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, 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 and 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
- Excellent written and verbal communication skills required
- Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
- Ability to perform stated physical tasks and operate office equipment
- Ability to follow directions, collaborate with others, and handle stress
Benefits:
- Smart-phone or electronic device capable of downloading applications provided/required for multifactor authentication and security purposes
- Equal employment opportunity and non-discrimination protections
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