Patient Account Billing and Credit Balance Representative
Patient Account Billing and Credit Balance Representative
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
HealthPartners is hiring for a Patient Account Billing and Credit Balance Representative.
QUALIFICATIONS:
REQUIRED TESTING:
Patient Accounting Terminology Test
Alphanumeric data entry 4000
35 WPM
REQUIRED:
High School Diploma or GED
Two years recent medical billing and collection experience
One year experience with automated health care practice management systems
One year PC experience including Microsoft Office Suite
Knowledge of basic accounting principles
Working knowledge of insurance terminology ICD CPT HCPCS and thirdparty billing and reimbursement procedures
Good communication skills written and verbal to establish and maintain effective working relationships with internal/external payers and customers
Ability to work and make decisions independently perform under deadlines and assume responsibility for problems and problem resolution
Must be detail oriented and have the ability to organize information
Must possess strong analytical and quantitative skills
Flexibility must be able to perform team duties as required to accomplish departmental goals and meet patient customer needs
Ability to work well under pressure
Demonstrated ability to maintain confidentiality and handle sensitive and confidential information per HIPAA and HealthPartners guidelines.
Demonstrated ability to adapt to new and different situations read the behavior of others have difficult conversations with ease and defuses and resolves conflict.
Demonstrated knowledge of insurance and medical billing office terminology
PREFERRED:
Working knowledge of the following medical systems: Epic Resolute
Working knowledge of billing and reimbursement policies of two or more insurance payors.
PHYSICAL REQUIREMENTS:
Ability to see (vision). Normal manual dexterity. Must be able to speak read and write English fluently. Ability to sit for prolonged periods of time.
POSITION PURPOSE:
Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. The Patient Account Representative Billing and Credit Balance is the primary link with the customer involving research resolving and providing responses to patients members prospective members HP personnel and third party payers on wide variety of subjects including billing coverage and services provided at HP. This position is accountable for accurate and timely resolution of claims and refunds to include denial management followup and third party collections.
ACCOUNTABILITIES:
Responsible for billing follow up/collection on assigned accounts with appropriate payers (i.e. governmental agencies attorneys patients insurance companies) to ensure an acceptable level of outstanding receivables as defined by corporate or department key process measures based on national standards.
Appropriately respond to billing and credit questions from colleagues peers and thirdparty payers.
Negotiate with thirdparty payers and patients to resolve outstanding insurance balances successfully
Work with appropriate department/clinic/administrative staff to resolve or facilitate resolution regarding questions and/or issues related to billing coding and denials.
Responsible for the understanding of insurance Coordination of Benefits and medical billing guidelines or laws.
Perform maintenance as needed on the patients insurance record to ensure accurate billing.
Responsible for reading understanding and complying with all departmental and jobspecific policies and procedures within the Department.
Responsible for follow up on account by performing necessary charge void and charge entry actions resulting from inquires or incorrect billings (i.e. coding waiver credits).
Reissue claims and statements when necessary and resubmit to appropriate parties.
Responsible for knowing and understanding benefit structures provided and administered by HealthPartners its subsidiaries and insurance companies.
Identify and propose solutions to problems which contribute to customer dissatisfaction in order to reduce future complaints or errors.
Assist in orientation for new Patient Accounting staff. Operates as a member of Patient Accounting Team in support of other staff.
Completes assigned projects and duties in a timely manner.
Inform management/supervisor of deficiencies and erroneous items or codes in Resolute (billing system) master files.
Reviews and interprets payer remittances to determine appropriate action to be taken on denied claims including an understanding of provider level adjustments (PLB).
Understand and comply with established workflows for corrected claims.
Submit insurance appeals with supporting documentation when warranted.
Identify when there is a need to appeal a refund request from a third party payer.
Compile and submit documentation for refunds due to patient and thirdparty payers when overpayments are requested or identified.
Work aged balances per assigned work direction/strategy outlined by management.
Coordinate with Coding and Billing personnel for correct and timely submission and/or resubmission of claims to thirdparty payers.
Post and reconcile both patient and insurance payments posted to set reconciliation methods as defined by management.
Produce and print demand claims as warranted.
Compare batch proofs and source documents for accuracy.
Contact third party payers to determine proper posting of payments as needed.
Resolve both undistributed and credit balance accounts while working from assigned worklist.
Research all aspects of the claim cycle to identify and correct errors which caused misappropriated funds.
Perform other duties as required to accomplish departmental goals and meet patient needs.
2
Required Experience:
Unclear Seniority
Employment Type
Unclear
