Patient Accounts Representative II/ Appeals and Denials
The Patient Accounts Representative position requires an experienced collector that understands AR follow up.The collector should have knowledge of how to appeal a denied claim and check status of a claim by payer website or placing a telephone call to the payer.
- Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients.
- Calls insurance companies or access payer website for claim status, appeal status on denied claims and payment reimbursement.
- Investigates & resolves denials, unpaid accounts, partially paid accounts and requests for information, including appeals.
- Identifies patients accurately and assigns the patient a unique identification number.
- Secures patient accounts in order to maximize reimbursements in a customer service oriented fashion.
- Maximizes the efficiency and accuracy of the collection process by up-front collection and maintaining bill hold reports.
- Provides documentation in the patient’s charts of general consent, information release, advanced care directives, and other requirements.
- Follows up on outstanding accounts and make proper notations (updating insurance information, using correct activity codes) in the Epic system.
- Resolves any unusual denials, low payments, or requests for information, including appeals.
- Reviews invoices to verify payments and contractual adjustments.
- Drafts letters to the insurance company’s Medical Review Board to expedite payment.
- Evaluates if payments were made according to contract.
- Updates patient information and file medical claims with correct information, via electronic or paper submission.
- Provides guidance and technical work direction to less experienced Patient Account Representatives.
- High school diploma or GED.
- Three years of relevant experience.
Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.
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