Healthcare Claims Representative

Company: AppleOne
Location: Saint Charles
Posted on: August 6, 2022

Job Description:

The Patient Account Representative I maintains follow-up and collection activity including letters, telephone and personal contact. Maintains patient financial file and documentation, advises, informs and assists the patient/guarantor/family in regard to hospital financial policies. Performs other various clerical responsibilities as may be assigned. Identification of problem or un-collectible accounts required. Hospital or Doctors Office Experience Demonstrates Competency in the Following Areas:1. Spot-checks documentation to ensure accuracy to ensure that all balances are correct before mailing to patient/guarantor.2. Is responsible for follow-up on all assigned accounts of in-house and/or discharged patients.3. Maintains and keeps current accounts assigned to collection work list to ensure a prompt follow-up.4. Begins follow-up on accounts no less than 20 days from billed date and continues every 14 days or less as required. (When working accounts with multiple unpaid cycles/claims all cycles must be worked.)5. Clearly documents in the patient accounting system every contact made to or by third party payor, patient, family or employee.6. Advises Business Office Manager of problem payors and/or accounts at time an issue is identified which may result in non-payment of claims.7. Monitors and records all payments made on patient accounts, prorates balance to next payor or patient, and changes financial class appropriately.8. Notes payment discrepancies and resolves within 48 hours.9. Identifies inaccurate guarantor/admit data to Business Office Manager if consistent to ensure appropriate corrective action at front end occurs.10. Is responsible for making sure that accounts have been properly worked before moving to next financial class for insurance or patient responsibility.11. Audits for accuracy and prepares all adjustments and/or refunds within 48 hours of discrepancy being identified and submits to manager for approval according to established departmental procedures.12. Scans or submits information to be scanned in patient files as needed to keep all supporting documentation.13. Performs any other duties as assigned by the Business Office Manager.14. Verifies and submits to Biller any additional information needed when billing (claim forms, EOBs, Medical Records, etc.)15. Sends request to patient for any necessary information (claim forms, account status, coordination of benefits, divorce decrees, termination of benefits letters, etc).16. Timely request bills for all secondary insurance and request re-files for any missing or lost bills.17. Correspondence is answered within 48 hours of receipt. AppleOne is proud to be an Equal Opportunity Employer. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment qualified applicants with arrest and conviction records.0-1 years

Keywords: AppleOne, Saint Charles , Healthcare Claims Representative, Healthcare , Saint Charles, Missouri