Patient Accounting Representative (Claims) II - PBFS Administration

Overview

Halifax Health is seeking a Patient Accounting Representative (Claims Processor) II for the PBFS - Administration Department.

Summary

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.

Job Qualifications

• Minimum high school graduate or equivalent required.
• Associate or bachelor’s degree or relevant certification from accredited institution 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 associates 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.

Job Duties and Responsibilities

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.

Process BAR Insurance Edit report by updating applicable account information daily.

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.

About Us

Recognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women’s health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization.

Halifax Health offers the area’s only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks.

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