Patient Accounts Representative II/ Appeals and Denials

Texas, United States
Salary Not Specified
Sep 10, 2020
Employment Type
Full Time


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.

Job Duties
  • 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.

Minimum Qualifications
  • 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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