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Patient Account Billing Representative

Manchester Community Health Center

Achieving better health outcomes, better patient care, and lowered costs through innovation and strong community partnerships.


The Patient Accounts Representative is responsible for various aspects of the revenue cycle process. This position primarily supports the Central Billing Office. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing and collections of accounts.

RESPONSIBILITIES & AUTHORITIES:

•Ensures that all claims are reviewed daily and submitted electronically in a timely manner using the claims management system.
•Reviews all claim edits/claim rejections and makes the necessary corrections ensuring compliance with all federal, state and specific commercial payor requirements.
•Works claims in an on hold status to ensure timely billing practices
•Coordinates data requests with other departments in support of timely billing. (Medical Records/Intake or Referral Center/Quality Review)
•Prepares and submits manual paper claims as needed to third party payors who do not accept electronic claims or who require special handling.
•Utilizes resources available to monitor outstanding claims for assigned payors (Workqueues/Aging Reports) and ensures claim follow-up does not exceed payor filing limits.
•Initiates re-billings, corrected claims and appeals following these specific payor requirements.
•Documents billing activities on the patient account to assist in problem resolution within Centricity CPS and/or EMR system.
•Identifies compliance risk and proactively recognize and rectify any issues to prevent payer audits.
•Uses in depth knowledge of contracts and reimbursement to obtain the proper resolution.
•Monitors assigned work to ensure billing and follow-up activities are maintained at the levels set by management.
•Establishes independent follow up processes on accounts worked to ensure payer response.
•Monitors and identifies claim rejections or denials for trends for the assigned payer and reports them to management.
•Upon receipt reviews and determines the proper disposition of claims with credit balances.
•Responsible for the daily reconciliation of charges, adjustments, and payments.
•Post Medicare, Medicaid, Blue Cross/Blue Shield, and other third-party payments. Maintain files. Pulls copies of paid/processed claims for the file. Follow-up unpaid claims within 45 days.
•Post commercial checks and denials to individual client accounts. Pull copies of paid/unpaid claims from files. Resubmit bills and/or follow-up with insurance company (or Client) when necessary. Post managed care additions and deletions.
•Interact with clients in a positive and professional manner; sensitive in approach to discussions with clients regarding financial matters.
•Generate patient statements and process Worker’s Compensation claims.
•Responsible for the collection of bad debt.
•Other responsibilities as assigned by supervisor.

How to Apply:

Please apply online https://pm.healthcaresource.com/cs/mchc/#/job/126

Job Location:

Manchester

Date Added: December 26, 2018

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