Description

Job Purpose

The Patient Account Representative - WCNF is responsible for collections, account follow up and hospital mail for the Workers Comp/No Fault accounts assigned to them.

Duties and Responsibilities

• 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 Workers Comp/No Fault claims
• 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.
• Verifies that information is accurate as to individual or insurance company responsible for payment of bill.
• Monitors all billing for accuracy, updating any that contain known errors.
• Follows up with insurance companies on all assigned accounts within expected timeframe
• Identify and report underpayments and denial trends
• Ability to analyze, identify and resolve issues causing payer payment delays Initiate appeals when necessary
• Meets and maintains daily productivity and quality standards established in departmental policies
• Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients
• Perform special projects and other duties as needed by the management team.
• Maintain confidentiality at all times
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Requirements

Qualifications

• High School Diploma or equivalent required
• Experience in Hospital/Facility billing preferred
• 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 work well individually and in a team environment.
• Proficiency with Microsoft Office including Excel and Word preferred
• Strong organizational, communication and written skills
• Basic math and typing skills

Working Conditions

• 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.