Denials Patient Account Rep - Audit Services FT Days

Core Competencies

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.

• Tracks the status and progress of denials and appeals.

• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.

• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues.

• Utilizes the Hospital's contract management system to identify accounts paid less than the expected reimbursement.

• Prepares, maintains, assists with, and submits reports, as required.

• Works with internal departments and external organizations to resolve appeals.

• Prioritizes workload requests to meet agreed upon deadlines.

• Collaborates with team members to continually improve services and engages in process and quality improvement initiatives.

• Identifies improvement opportunities and contributes to the testing of system modifications; works with IT staff and department managers to ensure proper implementation.

• Identifies and resolves problem issues independently.

• Elevates issues as appropriate to Supervisor.

• Promotes positive customer relations.

Department Specific Competencies

• Answers the telephone courteously within three rings, identifying self and department, routes calls, ascertains needs and takes accurate messages as appropriate.

• Interprets patient insurance benefit information and explains the amount allowed and paid by the customers insurance plan and how the amount owed by the patient was determined.

• Maintains advanced knowledge of payer-specific billing, claims processing requirements, payer regulations and payer best practices.

Education

Experience

Compensation Range

$25.64 - $38.82 / Hour