Job Description
Account Representative
Bellaire, TX
Contract / Temporary
$21.00 – $21.00 / Hourly
Description
Medical Account Representative
3 positions open for a Medical Account Representative 98% remote, will have occasional onsite trainings in Houston, TX
The Medical Account Representative will be able to work a flexible schedule 8 hours between 7am and 6pm Monday Through Friday.
To qualify for this position your resume must reflect all the following requirements.
- General knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations.
- The knowledge of how managed care plans work and the requirements for insurance coverage and benefits.
- Ability to communicate effectively both oral and written, good interpersonal skills; decision-making skills; professional courtesy; the ability to operate a PC and general office equipment.
- Account Representatives must have a strong math aptitude to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations.
- Hospital Revenue Cycle and Insurance Collections experience for government entities 2+ years current experience
- Traditional Medicaid and Managed Medicaid Plans collections is required 2+ years current experience
- This includes appealing insurance claim denials, underpayments, and understanding root cause analysis of insurance related activities.
- Must have Billing and general pediatric facilities and DRG reimbursement experience 2+ years current experience.
- 2+ years’ experience with larger facilities and have a track record of being able to adapt to both quality and productivity standards.
Applicants who do not have Hospital insurance collections experience and a minimum of 2 years of current job history with the above specifics will not be considered.
The Duties of the Medical Account Representative will include:
- Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures
- Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes.
- Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Ensures that all accounts associated with that guarantor and payor relationship are resolved
- Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance
- Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager.
- Refers problem accounts to Sr. Rep, Team Lead or Manager prior to accounts becoming 60 days old.
- Documents the issues in detail and refers to Sr. Rep, Team Lead or Manager with a recommendation of action needed.
- Provides continual follow-up.
- Assists with special projects to ensure that collection, work queue, and departmental goals are met.
Requirements
- Documentation, Procedures, Policy, Payment Processing, Planning Processes, Quality, Insurance, Medical Coverage, Benefit Functions, Billing, Collection Processes, Claim Administration, Regulation, Facility, Financial Notes, Answer, Clinical Trial Operations, Receipt, Web App, Interpersonal Skills, Lead Special Projects, Reimbursements, Decision-Making, Entity Formation, PC OS