Patient Account Representative – Hospital Medicare Experience

• Perform collections, account follow-up, and billing allowance posting for assigned accounts
• Follow up with payers by phone, email, fax, or websites to resolve outstanding claims
• Review and accurately update patient and financial information
• Verify the individual or insurance company responsible for bill payment
• Monitor billings for accuracy and correct errors
• Monitor Medicaid/Healthy Options coupons to ensure services are billed within expected timeframes
• Bill hospital services correctly and promptly to primary insurers or patients
• Explain hospital payment regulations and maintain knowledge of insurance regulations and hospital insurance contracts
• Identify and report underpayments and denial trends
• Analyze and resolve issues causing payer payment delays and initiate appeals when necessary
• Manipulate Excel spreadsheets and communicate results
• Meet daily productivity and quality standards
• Interact professionally with patients, insurance payors, co-workers, management, and clients
• Maintain confidentiality and protect, use, and disclose PHI in accordance with HIPAA
• Comply with Information Security and HIPAA policies and procedures
• Limit PHI access to the minimum necessary
• Perform other duties as assigned

Requirements

• High School Diploma or equivalent required
• Medical Billing and Coding certification preferred, but not required
• Experience in Hospital/Facility billing required
• 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, and UB-04
• Ability to use workflow and client host systems such as STAR, SMS, EAGLE and EPIC
• Working knowledge of insurance follow-up processes and healthcare reimbursement methodologies
• Understanding of government, Medicare and Medicaid claims
• Basic math and typing skills
• Proficiency with Microsoft Office Suite
• Strong interpersonal and communication skills
• Strong problem-solving and creative skills, with sound judgment and decision-making ability
• High level of integrity and dependability, with a strong sense of urgency and results orientation
• Excellent written and verbal communication skills required
• Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
• Ability to follow directions, collaborate with others, and handle stress

Core Competencies

Demonstrates expertise in medical billing and coding, including knowledge of ICD-9/10, CPT, and HCPC codes, while ensuring compliance with HIPAA regulations. Proficient in managing insurance collections and follow-up processes, with a strong focus on accuracy and timely billing.

Highest-signal resume keywords

• Medical Billing And Coding Certification
• Hospital/Facility Billing Experience
• Insurance Collections Experience
• ICD-9/10, CPT And HCPC Codes Knowledge
• Proficiency With Microsoft Office Suite

Hard Skills

• Medical Billing
• Insurance Claims Processing
• Data Analysis
• Excel Spreadsheet Manipulation
• Healthcare Reimbursement Methodologies
• Government Claims Understanding
• Basic Math Skills
• Typing Skills
• Workflow Systems Knowledge
• Client Host Systems Experience

Soft Skills

• Interpersonal Skills
• Communication Skills
• Problem-Solving Skills
• Decision-Making Ability
• Collaboration Skills

Certifications & Qualifications

• Medical Billing And Coding Certification

Industry Keywords

• HIPAA Compliance
• Insurance Regulations
• Medicare Claims
• Medicaid Claims
• Patient Financial Information

Tools & Technologies

• STAR
• SMS
• EAGLE
• EPIC
• Microsoft Office Suite