Patient Accounting Representative II - Claims

Patient Accounting Representative II - Claims

Responsible for processing insurance claims in a timely and accurate manner as well as performing timely and effective follow-up on patient accounts in order to insure prompt payment in accordance with insurance payer and established guidelines.

• Minimum high school graduate or equivalent required. Associate or bachelor's degree or relevant certification from accredited institution preferred.
• EPIC experience preferred. Requires a minimum of four years previous experience in healthcare, with two years of claim processing experience, preferably in physician billing (or one year of relevant claims processing experience with an associate or bachelor's degree), with complete familiarity of the third party billing and collection process. Prefer experience in an electronic claim processing environment and familiarity with 1500 claim form requirements. Must have general PC operational knowledge and skills.
• Correct claims with pre-bill rejections / warnings for both electronic and hardcopy claims on daily worklist.
• Provide payer with the necessary billing information to expedite payment in accordance with insurance payer guidelines.
• Hold codes must be placed on claims that cannot be resolved within the daily claim file.
• Review and ensure timely follow-up on all held claims daily.
• Review electronic rejected claims returned by the payer (277 payer responses) for appropriate action to submit corrected claims.
• Respond to payer remittance denial reasons by providing requested information and / or submitting an appeal as needed for accurate adjudication of the claim.
• Responds to department tasks within two working days.
• Maintains current knowledge of CPT / HCPCS and ICD-10 coding in accordance with insurance payer guidelines for UB92 and 1500 claim forms.
• Maintain current knowledge of Medicare and Medicaid compliance guidelines.
• Maintains knowledge of insurance payer contracts in accordance with insurance payer guidelines to ensure correct billing practices.
• Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with co-workers and customers.

Other duties as assigned.