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.
this is an onsite position in helena, montana! remote work is not an option 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
