Guidehouse

Patient Account Representative – Medicare, Medicaid, Commercial Claims

Guidehouse

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $34,000 - $56,000 per year

Job Level

Junior

About the role

  • The Insurance Patient Account Representative is an extension of a client’s business office staff.
  • Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances.
  • All client policies and procedures are followed.
  • Facilitates the billing and collection processes of outstanding accounts receivable.
  • Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts.
  • Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns.
  • Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers.
  • Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file.
  • Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated.
  • Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate.
  • Performs follow-up processes on accounts to work towards a zero balance.
  • Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim.
  • Performs balance transfers UB-04 & CMS 1500.
  • Complete all business-related requests and correspondence from patients and insurance companies.
  • Responsible for working on average 35 Accounts Per Day.
  • Complete all assigned projects in a timely manner.
  • Assist client and patients in all requested tasks.
  • Communicate to Guidehouse management areas of concern or areas of improvement.
  • Research and respond to all patient inquiries received by telephone and mail.
  • Update patient demographic information and initiate account adjustments.
  • Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

Requirements

  • High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED.
  • 6 months - 2+ year's experience in office, business, operations, customer service or healthcare field.
  • Previous experience working in insurance portals
  • PC skills in a Windows environment.
  • Knowledge and utilization of desktop applications to include Word and Excel is essential.
  • Ability to initiate and follow through on projects and work independently with minimal supervision.
Benefits
  • Medical, Rx, Dental & Vision Insurance
  • Personal and Family Sick Time & Company Paid Holidays
  • Position may be eligible for a discretionary variable incentive bonus
  • Parental Leave
  • 401(k) Retirement Plan
  • Basic Life & Supplemental Life
  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  • Short-Term & Long-Term Disability
  • Tuition Reimbursement, Personal Development & Learning Opportunities
  • Skills Development & Certifications
  • Employee Referral Program
  • Corporate Sponsored Events & Community Outreach
  • Emergency Back-Up Childcare Program
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
billingcollectionsclaims analysiscodingaccount adjustmentsbalance transfersUB-04CMS 1500customer serviceinsurance portals
Soft Skills
communicationproblem-solvingindependenceattention to detailtime managementorganizational skillsteam collaborationadaptabilitycustomer relationsproject initiation
Certifications
High School DiplomaGED