Patient Accounting Representative - Claims Processor

Day (United States of America)

Patient Accounting Representative - Claims Processor

This individual will assist and lead the Patient Accounting Representative team under guidance of the supervisor. Assist in escalated issues with patients, guarantors and third parties on accounts to resolve any questions or concerns towards satisfying account balances with patient/third party liability. Assess all options to patient’s account including payments, contracted payment plans, and financial assistance. Help create worklists and reports to identify account resolution for Patient Accounting Rep team. Help team identify any charity or financial assistance needs; all documentation and coordination with patients will be worked until determination of approval. Document all patient/ third party activity and communication in host systems.

- Minimum high school graduate or equivalent required. Associates or Bachelor’s degree from accredited institution is preferred.
- Minimum of two years experience in healthcare billing and/or business office setting, preferably in hospital billing.
- Must be able to communicate with patients effectively while maintaining customer service expectations.
- Preferred experience in Meditech and/or Athena EMR systems.
- General PC knowledge in business setting is required.
- Must have good oral and written communication skills.AUTO RECOVERY SPECIALIST  
- Establish contact with payers and follows up in accordance with established policies and procedures
- Properly executes requests for information including but not limited to COB, accident details, medical records requests
- Attempt to contact the Patient/Guarantor by using all resources when contact must be made to resolve an account with insurance, including but not limited to: contacting the NOK, PTN and the guarantor(s) employer when necessary to make contact.
- Send letters to patients based on circumstances of the account to effectively resolve the matter
- Secure any available insurance information and properly reports for billing
- Obtain crash reports after all other efforts have been exhausted including contacting patient
- Utilize E-Premis as necessary to re-print claims for insurance purposes
- Follow up with insurance companies timely to ensure payment
- Document all activity in patient accounting system with 100% efficiency and accuracy including but not limited to all conversations with insurance carriers and/or patients
- Work all system generated reminders daily keeping work lists current with no reminders older than 14 days
- Maintain knowledge and a current understanding of the PIP statute and auto related issues
- Appropriately refers accounts to be moved to SP when appropriate and consistent with policy for insurance time out
- When working accounts, also addresses physician bills for payment and settlement
- Processes requests from insurance companies timely including EOB’s, accident details
- Uses sound judgment to only pursue third party tort feasors when health insurance benefits are minimal and are not conflicting with HMO balance billing laws
- Monitor accounts to ensure timely filing deadlines are not missed due to waiting on third party information
- Ability to communicate effectively with customers
- Assist other team members and departments in completing assignments
- Comply with HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received, handled or shared.
- Demonstrate compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
- reporting any infractions using the appropriate chain of command and without fear of retribution.
- Perform additional duties as assigned by management.   BILLING
- Process insurance claims in a prompt and accurate manner, meeting all corresponding performance standards.
- Demonstrates the ability to evaluate and resolve accounts by utilizing resources including, but not limited to, bills, remittances, correspondence, worklist and insurance calls in accordance to payer specific guidelines in a timely manner.
- Corrects and processes rejected and hardcopy claims in a timely manner.
- Demonstrates proficiency in the billing systems and accounts receivable systems, keeping abreast of all changes.
- Maintains current knowledge of HCPC and UB04 coding in accordance with specific insurance payer guidelines.
- Assigns appropriate date to follow up with insurance carrier to ensure prompt payment.
- Updates billing and registration systems with any demographic/insurance revisions the same day received.
- Follows up on all denied, rejected and/or pending claims in a timely manner, utilizing all electronic means available.
- Maintains ability to bill specialty accounts which include, but not limited to, cycle bills, audit bills, split bills, DME, carve-outs, in-house denials, SDS, etc.
- Analyze and follow up on any late charges credited or debited on accounts in accordance with established guidelines.
- Ensure account information is current by entering notes, documentation and changes at time of occurrence.
- Research and determines required adjustment information as deemed necessary in accordance with insurance payer.
- Obtains and supplies insurance carriers with necessary account information to expedite payment.
- Meets and/or exceeds production goals as defined.
- Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with coworkers and customers.
- Duties as assigned.   COLLECTIONS
- Review patient account for accuracy of insurance coverage information.
- Evaluate Self Pay Liability on patient and guarantor balances.
- Work with patients in need of financial assistance while reviewing all required financial information from the patient/guarantor.
- Assist in monitoring AR levels of the department and align collection attempts with policy.
- Work with 3rd party affiliates to review accounts and obtain account resolution.
- Make all possible attempts to assist patient with resolving account balance timely.
- Procure patient letters when other form of communication is not possible.
- Collect payment on patient balances processing them electronically.
- Establish and monitor contracted payment arrangements with patients.
- Document all patient contact and activity with efficiency and accuracy in billing systems.
- Update billing systems with all demographic and/or insurance revisions timely.
- Review patient Explanation of Benefits to determine correct patient responsibility.
- Understand non-commercial insurance plan processes with payers like Medicaid, Medicare, Auto, Workers Comp, etc.
- Comply with HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received, handled or shared.
- Communicate in a respectful, positive way with fellow colleagues.
- Demonstrate compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
- reporting any infractions using the appropriate chain of command and without fear of retribution.
- Perform additional duties as assigned by management.   CUSTOMER SERVICE  
- Manage 40/60 inbound/outbound calls daily for patients and guarantors with a complete account review.
- Respond to correspondence received including requests for information, updates, claim processing, etc, within 24 hours of receipt.
- Work with 3rd party affiliates to review accounts and obtain account resolution.
- Ensure patient knowledge of collection stream that the business office follows to obtain account balance due.
- Make all possible attempts to assist patient with resolving account balance timely.
- Procure patient letters or emails when other form of communication is not possible.
- Collect payment on patient balances processing them electronically.
- Establish payment arrangements with patients.
- Document all patient contact and activity with efficiency and accuracy in billing systems.
- Update billing systems with all demographic and/or insurance timely.
- Review patient Explanation of Benefits to determine correct patient responsibility.
- Understand non-commercial insurance plan processes with payers like Medicaid, Medicare, Auto, Workers Comp, etc.
- Send and review incoming faxes.
- Collaborate with other business office departments for account resolution.
- Review and distribute all business office mail.
- Demonstrate compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
- reporting any infractions using the appropriate chain of command and without fear of retribution.
- Comply with HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received handled or shared.
- Assist patient with setup and maintaining Halifax Patient Portal.
- Ability to act independently and efficiently while performing duties accurately and timely.
- Perform additional duties as assigned by management.   FINANCIAL COUNSELING  
- Review patient account for accuracy of insurance coverage information.
- Estimate charges using system and grant estimates upon request.
- Collect payment on patient balances processing them electronically.
- Evaluate patient assistance and charity programs to grant uninsured patients.
- Document all patient contact and activity with efficiency and accuracy in billing systems.
- Update billing systems with all demographic and/or insurance revisions timely.
- Collect and record all patient required documents for review of assistance.
- Knowledgeable of HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received, handled or shared.
- Demonstrate a positive and friendly demeanor even in stressful situations to ensure a positive experience for all customers.  
- Communicates in a respectful, positive way with fellow colleagues. 
- Comply with HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received, handled or shared.
- Demonstrate compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
- reporting any infractions using the appropriate chain of command and without fear of retribution.
- Perform additional duties as assigned by management.   LEGAL SPECIALIST  
- Review and respond to requests for itemized bills from attorneys per Halifax Health policy and procedure; adheres to HIPAA guidelines
- Review and respond to requests for itemized bills from outside billing companies within timeframe indicated on request; adheres to HIPAA guidelines
- Review and respond to Subpoenas for itemized bills within timeframe indicated on Subpoena
- Reviews account(s) when death certificate received; task received advising patient deceased, etc., for balance owing, review for Estate filed; places account in appropriate BD agency, forwards to Supervisor if further review/action needed.
- Work all system generated reminders weekly keeping work lists current with no reminders older than 7 days
- Communicate with attorney offices giving current balances and/or insurance information
- Liens are scanned on account when received from Courthouse and CDS screen is updated with recording
- information
- Filing is kept current and organized
- PBFS Legal email is worked daily and kept current
- Open and distribute incoming Legal faxes daily
- Open and distribute Legal mail/correspondence daily
- When deemed necessary, recommends account(s) be referred to Supervisor for review after all actions have been exhausted to properly resolve the account
- Document all activity in patient accounting system with 100% efficiency and accuracy
- Exhibit and promotes positive customer service when working with attorney offices and patient
- Ability to communicate effectively with customers
- Comply with HIPAA regulations to ensure the confidentially and security of protected health information (PHI) when it is received, handled or shared.
- Demonstrate compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
- reporting any infractions using the appropriate chain of command and without fear of retribution.
- Perform additional duties as assigned by management.     REIMBURSEMENT
- Timely and accurate posting, adjusting and reconciling of funds received via lockbox payments, electronic funds transfers and mail with posting accuracy of 99% or greater.
- Forwards potential third party or patient refunds to the Refund Specialist based on credit balances created from payments and/or adjustments posted to patient’s accounts.
- Responds to system or manual tasks in a timely manner.
- Prepares daily reconciliation of cash posting to Accounting Department.
- Applies payroll deductions within 48 hours of receipt.
- Applies payments and adjustments not completed by electronic remittance posting.
- Prepares remote bank deposits and processes credit card transactions daily with 100% accuracy.
- Correctly identifies remittance codes and applies them to individual patient’s accounts as received by insurance companies. Validate track and trend remittance codes for process improvement.
- Correctly identifies underpaid claims in accordance with hospital insurance contracts by applying underpayment codes correctly to patient’s accounts, based off information received by insurance companies.
- Post insurance payments to the correct insurance plans as identified by hospital contracts. Updates patient accounts with corrected insurance plans. Track and trend insurance plan errors and forward to registration areas for improvement.
- Performs research related to unidentified payments received to determine the appropriate accounts for posting.
- Review and complete correspondence and faxes in a timely manner.
- Contributes to effective working relationships by demonstrating a positive and helpful attitude with co-workers.
- Maintains privacy strictly adhering to HIPAA guidelines.
- Performs other duties as assigned.
- Processes third party and patient refunds in adherence with company policy.
- Researches credit balance accounts for possible refund or retraction.
- Reviews incoming refund requests, via mail or fax from insurance or audit companies, for validity and responds appropriately.
- Sends any necessary adjustments, posting corrections or payment transfers to the Payment Poster Specialist.
- Coordinates refunds/retractions with third party vendors working on behalf of Halifax Health in accordance with company policy.
- Compose letters or faxes disputing refunds to insurance or audit companies.
- Call insurance companies to obtain additional information concerning the credit balance.
- Complete audits from insurance companies or internal compliance in a timely manner.
- Submits refund posting report to the Accounting department weekly.
- Responds to system tasks in a timely manner.
- Contributes to effective working relationships by demonstrating a positive and helpful attitude with co-workers.
- Maintains privacy strictly adhering to HIPAA guidelines.
- Performs other duties as assigned.