Patient Account Representative

Summary :

The Staff Pad is honored to partner with a non-profit healthcare system in Helena, Montana with superior care and a hometown commitment to be the gold standard for health care in Montana.

We are in search of a Patient Account Representative to join their team.

Responsibilities

• Performs pre-billing and billing functions to insure successful outcome of claim submission and payment.
• Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance.
• Collaborates with all Team Members within SPH to insure an accurate and timely billing.
• Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership
• Utilize various A / R reports to target aged balances for collection to meet and maintain performance goals.
• Evaluate partial payments to determine if further reimbursement is valid
• Compose technical denial arguments for reconsideration, including both written and telephonically
• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
• Escalate exhausted appeal efforts to Leadership
• Submits retro authorization to insurance within insurance carrier guidelines
• Researches and takes necessary action to follow up on unpaid claims using ATB’s and / or assigned work lists
• Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse
• Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess
• Use effective documentation standards that support a strong historical record of actions taken on the account
• Reviews and follows through on credit balances through take back initiation, refund initiation, and / or payment re-application.
• Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation
• Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports.
• Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference.
• Response to all queries timely to insure Gold Standard Customer Service
• Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations

Qualifications

KNOWLEDGE / EXPERIENCE :

• Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory
• Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory
• Proficient keyboard / 10 key skills and working knowledge of computers required.
• Good verbal and written communication skills.
• Strong data entry, ten key skills and working knowledge of computer required.
• Exceptional customer service and interpersonal communication skills.
• Proficient in examining documents for accuracy and completeness.
• Ability to multitask and manage time effectively.
• Ability to grasp, retain, and apply new regulations
• Mathematical, organization skill and business correspondence skills.
• Basic knowledge in downloading / creating spreadsheets in Microsoft Excel

EDUCATION : High School diploma or GED required. Completes Patient Financial Services I training within first 5 month

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