Patient Account Representative at United Musculoskeletal Partners

Dunwoody, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

20 May, 26

Salary

0.0

Posted On

19 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Claims, Third-Party Payors, Claim Resubmission, Appeals, Productivity Standards, Denial Prevention, Medicare, Medicaid, Commercial Payors, AR Collections, Physician Billing, EMR, Athenahhealth, CPT-4, ICD-10, HCPCS Coding

Industry

Hospitals and Health Care

Description

Description As a key member of the post service denials team, the Denials PAR will: Expedite and maximize payment of insurance medical claims by contacting third-party payors and patients including resubmission of claims, corrected claims, appeals, etc. Complete post service denial tasks in accordance with established productivity and performance standards. Collaborate with management in developing a plan to reduce aging of accounts with efficiency and maximum results. Effectively communicate and collaborate with management to determine escalation of denied claims. Identify claims processing issues upstream for denial prevention. Demonstrate the expertise of all payors, including Medicare, Medicaid, and commercial payors. Assist with knowledge sharing, payor, and department training, and provide support to other team members as advised by the manager and/or supervisor. Identify, analyze, and escalate trends impacting AR collections. Execute special projects to improve AR performance, as assigned Requirements EDUCATION AND EXPERIENCE Three years physician billing experience, preferably in a large orthopedic physician practice. Knowledge of EMR (Electronic Medical Record) (athenahealth preferred). SKILLS/ABILITIES Ability to critically think through next steps on at risk accounts and resolve with optimal outcome. Ability to prioritize workload for maximum benefit on aging accounts and to ensure that accounts do not age out beyond timely filing limits. An ability to identify upstream blockers, prioritize solutions and communicate effectively. Excellent communication and influencing skills; proven experience of influencing other teams/groups where their support is critical to success. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development. In-depth knowledge of CPT-4, ICD-10 and HCPCS coding, along with CCI edits. Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology. Managed care knowledge with the ability to differentiate between insurance plans such as Preferred Provider Organization (PPO), Point of Service (POS), Health Maintenance Organization (HMO), etc. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development. Ability to effectively communicate with physicians, clinic staff, patients, and co-workers consistent with a customer service focus and application of positive language principles. In depth knowledge of third-party payer reimbursement policies and procedures

Responsibilities

The representative will expedite and maximize payment of insurance medical claims by contacting third-party payors and patients, handling tasks like claim resubmission and appeals according to performance standards. They must also collaborate on reducing account aging and identifying upstream claims processing issues for denial prevention.