Patient Account Representative - Medicare/Medicaid Exp

Med-Metrix; Arlington, Northern (VA, KY); Hybrid; USD 42,000 - 56,000; Full time

Job summary

Med-Metrix seeks a Patient Account Representative responsible for collections, account follow up, and posting of billing allowances for assigned accounts. You will work with payers by phone, email, or portal to resolve claims efficiently.

The role requires attention to accuracy, understanding of Medicaid/insurance rules, and proficiency with Microsoft Office. HIPAA compliance and confidentiality are essential in daily duties.

Qualifications

• 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.

Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
• Review and updates all patient and financial information accurately as given.
• Verify that information is accurate as to individual or insurance company responsible for payment of bill.
• Monitor all billings for accuracy, updating any errors.
• Monitor Medicaid/healthy options coupons to assure services are billed within expected timeframes.
• Bill all hospital services to primary insurer or patient correctly and within expected timeframe.
• Follow up with insurance companies on all assigned accounts within expected timeframe.
• Explain hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts.
• Identify and report underpayments and denial trends.
• Analyze, identify and resolve issues causing payer payment delays; Initiate appeals when necessary.
• Manipulate excel spreadsheets and communicate results.
• Meet and maintain daily productivity and quality standards established in departmental policies.
• Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients.
• Maintain confidentiality at all times.
• Other duties as assigned.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with HIPAA standards.
• Understand and comply with Information Security and HIPAA policies and procedures at all times.
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Skills

Strong communication

Microsoft Office

Attention to detail

Problem solving

Teamwork

Typing speed

Education

High School Diploma

Medical Billing and Coding certification

Tools

STAR

SMS

EAGLE

EPIC

Job description

Job Purpose

The Patient Account Representative is responsible for collections, account follow up, billing allowance posting for the accounts assigned to them.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
• Review and updates all patient and financial information accurately as given
• Verify that information is accurate as to individual or insurance company responsible for payment of bill
• Monitor all billings for accuracy, updating any errors
• Monitor Medicaid/healthy options coupons to assure services are billed within expected timeframes
• Bill all hospital services to primary insurer or patient correctly and within expected timeframe
• Follow up with insurance companies on all assigned accounts within expected timeframe
• Explain hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts
• Identify and report underpayments and denial trends
• Analyze, identify and resolve issues causing payer payment delays; Initiate appeals when necessary
• Manipulate excel spreadsheets and communicate results
• Meet and maintain daily productivity and quality standards established in departmental policies
• Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients
• Maintain confidentiality at all times
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• 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, as well as UB-04
• Ability to use various workflow system and client host system such as STAR, SMS, EAGLE and EPIC, as well as other tools available to them to collect payments and resolve accounts
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Understanding of government, Medicare and Medicaid claims
• Basic math and typing skills
• Proficiency with Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the 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 oriented
• Excellent written and verbal communication skills required

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.