Patient Accounts Representative

Saint Luke's; Kansas City (MO); On-site; USD 42,000 - 60,000; Full time

Job summary

Saint Luke's Health System is seeking a Patient Account Representative to review and audit billing charges, posting payments and resolving claim edits for physician clinics within the system.

Responsibilities include researching claim errors, resubmitting denials, coordinating with payors, and supporting coding activities. Preferred certification in Billing or Coding. Full-time, on-site in Kansas City, MO.

Qualifications

• 1 year of applicable experience in medical billing or accounts receivable.
• Experience researching and correcting coding/claim errors.
• Able to work with payors and resolve denials and appeals.

Responsibilities

• Research patient billing claims to correct coding/claim errors.
• Research insurance coverage to identify and resubmit claims to fix coverage denials.
• Outline documentation needed for payor organizations so that claims are processed correctly.
• Familiarity with NCCI edits, incidentals/inclusive, and bundling rules.
• Identify problem trends and communicate with payors for resolution.
• Responsible for 277 EDI transactions/rejections.
• Work with EDI transactions and payment postings/adjustments.
• Correct/enter charges and distribute payments.
• Coordinate work with multiple teams to resolve issues.
• Coordinate payment plans or financial assistance when needed.

Skills

1 year experience in medical billing

Strong communication with payors

Attention to detail

Education

Billing or Coding Certifications (preferred)

Tools

EDI transactions systems

NCCI edits knowledge

Job description

Job Description

The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, entering charge demographics, troubleshooting charge related issues raised by clinic staff, responding to inbound and outbound billing calls from patients, payment posting, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues. The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, entering charge demographics, troubleshooting charge related issues raised by clinic staff, responding to inbound and outbound billing calls from patients, payment posting, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues.

Job Description

The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, entering charge demographics, troubleshooting charge related issues raised by clinic staff, responding to inbound and outbound billing calls from patients, payment posting, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues.

Preferred: Billing or Coding Certifications.

Claim Edits

• Responsible for researching patient billing claims to identify and correct coding/claim errors
• Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage denials.
• Research and outline documentation needed for respective payor organizations so that claims are processed correctly
• Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc.
• Identify problem trends
• Communicate with payors for resolution to complications with claims
• Responsible for 277 EDI transactions/rejections
• Working with EDI transactions
• Payment posting corrections/adjustments and ability to distribute payments
• Correct/enter charges
• Work with multiple teams/departments to resolve issues
• Payment plan or financial assistance coordination

Insurance Denials and Follow-Up

• Responsible for researching, identifying errors, and correcting claims denied by insurance companies.
• Must be able to asses claim to determine when appropriate to make charge adjustments, void a charge, or escape to the team lead and/or another medical billing team.
• Responsible for writing appeal letters to insurance companies
• Responsible for following up with insurance companies for no response claims.
• Responsible for working with patient calls escalated from the Customer Service team regarding involving billing code issues.
• Research refund request from payor organizations
• Responsible for preliminary audit of billing code errors before claim submitted to the Coding team.
• Responsible for routing complex claim denial to team lead and/or the appropriate medical billing team.
• Responsible for identifying issues which can be resolved by programing software to prevent denials.
• Responsible for becoming a subject matter expert on the payor policies.
• Responsible for communicating and resolving problems with the provider representatives
• Responsible for simple level coding, including diagnosis review, modifier applications, some CPT code changes following process documents and payor policies

Job Requirements

Applicable Experience:
1 year

Job Details

Full Time
Day (United States of America)