Senior Patient Account Rep- Day

Overview

Senior Patient Account Rep

Responsible for the reporting, monitoring, analysis, and follow-up of denials.  Identifies whether a denial can be appealed or if a write-off is required.  Provides appropriate denial information to root cause areas to ensure systems, processes and measures of effectiveness (e.g. remediation action plans) are created and implemented to reduce/eliminate denials.

Specializes in the optimal reimbursement of patient accounts including investigative research, collection duties, and complex account follow-up. The position has a major impact on converting accounts receivables into cash and accurately recording contractual adjustments impacting financial statements.  May communicate extensively with management in other departments, insurance companies, governmental agencies, patients, physician offices, and co-workers to collect and process information relative to claims payment.  Performs account reconciliations and analysis requiring calculation of basic and complex calculations including multiple reimbursement methodologies within one account, stop loss, DRG groupers, APC calculations, coordination of benefits, insurance accounts receivables (IAR’s), fee schedules, and patient liability.  Uses a variety of resources and information systems to extract, enter, and analyze data, including the UB-92 editor, ICD-10, and CPT-4 reference guides.  Responsible for all other duties as may be necessary to ensure timely payments of accounts receivable

 Education, and Experience: 

• Must be a High School or GED Diploma Graduate.  Bachelor’s Degree preferred.
• Experience in accounting, insurance, collections, or other related fields