Patient Account Representative – Medicare, Medicaid, Commercial Claims

📋 Description

• The Insurance Patient Account Representative functions as an extension of a client’s business office team.

• Representatives are tasked with incoming and outgoing communications with patients and insurance companies to resolve account balances.

• They facilitate the billing and collection processes for outstanding accounts receivable.

• The role involves communicating with both internal and external contacts to clarify primary, secondary, and tertiary billing, collection, and claims resolution, including those related to Medicare and other governmental and non-governmental accounts.

• Monitors daily queues for customer service quality and productivity, ensuring compliance with departmental standards; alerts management to patterns of high call volume.

• Manages incoming and outgoing billing correspondence and phone inquiries from patients, third-party administrators, attorneys, vendors, and various insurance payers.

• Records discussions and actions taken to support all claims inquiries, reviews, and reconsiderations; optimizes the follow-up process for team members assisting with the file.

• Analyzes claims to ensure compliant and accurate coding and charging, confirming that demographic and billing information is up to date.

• Works to resolve any claims or billing issues and escalates concerns to management as necessary.

• Conducts follow-up procedures on accounts aiming for a zero balance.

• Submits timely reconsiderations or reviews of claims with supporting documentation, such as corrected claims, medical records, and letters of explanation as required; liaises with departments to gather necessary information for claim resolution.

• Performs balance transfers using UB-04 and CMS 1500 forms.

• Completes all business-related requests and correspondence from patients and insurance companies.

• Responsible for managing an average of 35 accounts per day.

• Completes all assigned projects punctually.

• Assists clients and patients in all requested tasks.

• Communicates any areas of concern or opportunities for improvement to Guidehouse management.

• Researches and responds to all patient inquiries received via telephone and mail.

• Updates patient demographic information and initiates account adjustments.

• Strives to resolve account balances to zero before accounts are forwarded to external collection agencies.

⛳️ Requirements

• High School Diploma / GED or 3 years of relevant equivalent experience in lieu of a diploma/GED.

• 6 months to 2+ years of experience in office, business, operations, customer service, or the healthcare field.

• Previous experience with insurance portals is preferred.

• Proficient PC skills in a Windows environment.

• Essential knowledge and use of desktop applications, including Word and Excel.

• Ability to initiate and complete projects while working independently with minimal supervision.

🏝️ Benefits

• Medical, Rx, Dental & Vision Insurance.

• Personal and Family Sick Time & Company Paid Holidays.

• Position may qualify for a discretionary variable incentive bonus.

• Parental Leave.

• 401(k) Retirement Plan.

• Basic Life & Supplemental Life Insurance.

• Health Savings Account, Dental/Vision, & Dependent Care Flexible Spending Accounts.

• Short-Term & Long-Term Disability Insurance.

• Tuition Reimbursement, Personal Development & Learning Opportunities.

• Skills Development & Certifications.

• Employee Referral Program.

• Corporate Sponsored Events & Community Outreach.

• Emergency Back-Up Childcare Program.