Patient Account Representative
Job Description
Job Description
LHH is seeking a Patient Account Representative to join our healthcare team. This remote role is perfect for Hawaii-based candidates who are passionate about patient care and want to work from home.
This is a remote, W2 contract but candidates MUST sit in Hawaii.
Job Summary:
Under indirect supervision, processes insurance claims, reports, and billing for compensation of patients and members for medical disability benefits. This role involves processing applications from medical/life insurance, supplemental benefits, and assigned accounts, obtaining background information, planning to obtain monies owing, and performing other collection responsibilities as needed. The representative abides by state collection and credit regulations, interprets and complies with state/federal regulations, laws, and guidelines in reference to third-party payers, processes VRs for billing, maintains current knowledge of health plan benefits and policies, and acts as a representative.
Major Responsibilities/Essential Functions:
· Receives, reviews, and controls requests for medical information, visit records, nurse/doctor notes, and other pertinent documents; verifies completeness and accuracy; ensures efficiency in processing of claims; obtains medical charts and other data pertaining to requests.
· Audits, abstracts, and summarizes pertinent data from patient medical records, nurse/doctor notes, and other documents; processes insurance claims and reports in compliance with state/federal regulations, laws, guidelines, and health plan policies; obtains physician signature and/or signs as provider representative; prepares service charge letters and invoices referring to fee schedule.
· Performs follow-up with insurance companies, agencies, and/or patients; researches and acts as required.
· Prepares and audits visit records and nurse/doctor notes using various fee schedules; prepares documents (e.g., charges, payments, adjustments) with Charge Description Master codes, required billing coding conventions, and batch totals.
· Communicates and corresponds effectively with insurance carriers, intermediaries, members, doctors, outside providers, and patients; provides in-service orientation to other departments/personnel; obtains complete and valid information; ensures collectability and maximum reimbursement of revenues.
· Maintains familiarity and open communication with state, federal, and community agencies, insurance carriers, intermediaries, and others within the organization; ensures proper and adequate exchange/interpretation of data and information; ensures maximization of payments.
· Collects monies owing for all inpatient/outpatient services rendered from third-party payers, employers, patients, guarantors.
· Contacts debtor by telephone and/or correspondence; arranges for collection of monies owing; abides by state and federal collection and credit rules and
regulations; schedules interviews with debtors; maintains positive customer relationships through effective communication and follow-up.
· Analyzes the history of delinquent accounts; determines whether accounts are collectible; prepares write-off accounts; attaches pertinent information to assist outside attorney; submits to supervisor for review; summarizes monthly write-off report (e.g., breakdown of amounts, service locations, date of service, H.P./N.P., and overall reason for assignment to collection agency).
· Generates appropriate adjustments; research documents and all other available sources to determine validity of adjustment; submits back-up to data entry for key punching function.
· Documents and records on HPMS computer system all collection action taken on individual accounts (e.g., data collection contact made, date of promised payment, credit arrangements, insurance filing date, and all other pertinent information); maintains tickler system to monitor promised payment.
· Skip traces all mail returns; research internal and external documents and all other sources to determine whereabouts of debtor; generates file maintenance to update patient demographics for rebilling when different address obtained.
· Operates standard office equipment; refers to difficult problems to supervisor.
· Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.
· Performs other duties and accepts responsibility as assigned.
Minimum Education: High school diploma or equivalent combination of education (lesser) & experience may be considered in lieu of requirements.
Minimum Work Experience and Qualifications:
· One (1) year collections or medical insurance claims processing experience.
· Demonstrated ability to perform diversified clerical functions and basic accounting procedures.
· Demonstrated ability to motivate debtors to pay.
· Demonstrated knowledge of and skill in adaptability, change management, conflict resolution, customer service, influence, interpersonal relations, oral communication, problem solving, teamwork, and written communication.
· Talking to co-workers, customers, outside vendors, and on the telephone.
· Reading, writing, speaking, understanding English. Training/giving and receiving instructions.
· Mathematical ability, attention to detail (e.g., organization, prioritization, proofing), concentration, and alertness.
Preferred Work Experience and Qualifications:
· Two (2) years’ collections experience in the healthcare field.
· Knowledge of medical terminology, CPT-4 and ICD-9-CM coding.
· Knowledge of mainframe collections applications.
· 10-key by touch.
· Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.
Specific Systems Knowledge Preferred: EPIC, Payer portals, Microsoft software.
Expected Shift: Monday - Friday, 7:00-3:30pm, 7:30-4:00pm, or 8:00-4:30pm HST.
Top Three Responsibilities: Timely and accurate follow-up of outstanding insurance accounts, contact with insurance carriers to check on claim status, resolve claim denials and rejections, escalating accounts requiring intervention to supervisors or legal/charity care processes as needed.
Top Three Skillsets: Problem-solving & critical thinking, attention to detail & organization, communication & negotiation skills.
Apply now to make a difference in patient services and grow your career with us. We look forward to welcoming you to our team!
Pay Details: $20.00 to $21.00 per hour
Search managed by: Jessica Vazquez
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
- The California Fair Chance Act
- Los Angeles City Fair Chance Ordinance
- Los Angeles County Fair Chance Ordinance for Employers
- San Francisco Fair Chance Ordinance