Job Information
St. Peters Health Patient Account Representative (1.0 FTE) in Helena, Montana
Performs pre-billing and billing functions to insure successful outcome of claim submission and payment.
Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance.
Collaborates with all Team Members within SPH to insure an accurate and timely billing.
Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership
Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals.
Evaluate partial payments to determine if further reimbursement is valid
Compose technical denial arguments for reconsideration, including both written and telephonically
Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
Escalate exhausted appeal efforts to Leadership
Submits retro authorization to insurance within insurance carrier guidelines
Researches and takes necessary action to follow up on unpaid claims using ATB’s and/or assigned work lists
Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse
Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess
Use effective documentation standards that support a strong historical record of actions taken on the account
Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application.
Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation
Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports.
Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference.
Response to all queries timely to insure Gold Standard Customer Service
Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations