Patient Account Representative

Overview

Performs all phases of Third Party Billing and Follow-up on services provided by EVMS Medical Group clinical staff.

Responsibilities

• Responsible for the electronic and manual billing to Third Party Payers in a timely, proficient fashion and maintaining the PayerPath system.
• Review all manual claim forms for accuracy prior to the claim submission.
• Understand the required attachments to claims, as they relate to CPT,ICD10 and modifier coding practices.  Reviews claims for appropriate documentation attachments.
• Ensure that all carrier requirements are supported with claims submitted.
• Communicate with the EVMS Medical Group clinical departments, hospitals, and patients to secure insurance data and/or medical documentation required to file claims.
• Operate the Touchworks Scan filing system to retrieve required documentation, referrals, and/or other pertinent data to file claims.
• Review IDX claim edit lists to make the necessary corrections to data input errors or missing information.
• Post the “insurance billed” paycode to all manual filed claims.
• Post the “Appeal Sent” paycode to all appealed claims.

Insurance Follow-up functions:

• Responsible for the timely follow-up, account research, and resolution of outstanding Third Party claims.
• Maintain an ETM work-file, as assigned by the Insurance Department Supervisor.
• Utilize the ETM tickler system to follow through on the carrier’s promise to pay claims.
• Identify and have corrections made to any CPT/ICD10/Modifier coding error that prohibits the claim(s) from the final adjudication process.
• Coordinate the exchange of insurance information with the EVMS Medical Group clinical departments to expedite claim processing.
• Identify appropriate adjustments to patient accounts for submission to the Senior PAR or the Insurance Department Supervisor.
• Prepare insurance claim forms on unpaid invoices in a timely fashion.
• Handle incoming calls from the insurance carriers and respond to their requests in a timely fashion.
• Other duties as assigned.

Qualifications

High School diploma/GED with basic computer and keyboarding skills. Must be able to communicate ideas clearly and follow written processes and procedures. Must have ability to maintain composure in stressful situations. Prior medical billing experience highly desired but not required.

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