Patients Account Rep - Specialty Pharmacy

Summary:

Responsible for accurate and timely billing and account collections.

Obtains required billing information / documentation (pre-certifications, codes, insurance information) and enters into database.

Identifies and resolves denied claims, escalating accounts as necessary to ensure timely payment of claims.

Assists customers with billing questions.

Prepares and maintains billing and related reports.

Position Responsibilities:

• Identifies items to be billed by procedure and services performed.

• Obtains necessary documentation for billing and obtains pre-certifications.

• Enters all charges and submits bills in accordance with Patient Accounting policy.

• Posts payments, performs daily reconciliations, produces daily census, and performs month end close.

• Maintains data in billing management system, i.e. updating current and adding new demographic information, and ensures that documentation entered is accurate and complete.

• Analyzes, identifies and trends billing issues to proactively reduce denials and variances.

• Works system generated reports such as residual balance, credits, no-pay.

• Reports and resolves variances and inefficiencies, escalating accounts as necessary to resolve billing issues.

• Interacts / communicates effectively with various department staff and assists customer service inquires both internally and externally: liaison with Patient Accounting and Physician billing services, employers and insurance carries to ensure accurate and timely billing process.

• Maintains open communication with management regarding billing and coding issues including documentation, denials/appeals, etc.

• Follows up on assigned insurances on a monthly basis and maintains records of declined claims requiring appeals.

Position Qualifications Required / Experience Required:

1-3 years experience in billing, collections, registration, or related hospital / office environment.

One year of Epic system experience highly preferred

Must have fast, accurate data entry skills.

Good organizational skills and attention to details.

Must be able to work in a fast paced environment with excellent customer service and interpersonal skills.

PC literate with a working knowledge of Microsoft Office applications (Word, Excel, Access)

Required Education:

High School diploma or equivalent.