Qureos Mentor

Med-Metrix

Job Purpose
 The Patient Account Representative is responsible for collections, account follow up, billing allowance posting for the accounts assigned to them.
 
Duties and Responsibilities
 <ul>
<li>Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites</li>
<li>Review and updates all patient and financial information accurately as given</li>
<li>Verify that information is accurate as to individual or insurance company responsible for payment of bill</li>
<li>Monitor all billings for accuracy, updating any that contain known errors</li>
<li>Monitor Medicaid/healthy options coupons to assure services are billed within expected timeframes</li>
<li>Bill all hospital services to primary insurer or patient correctly and within expected timeframe</li>
<li>Follow up with insurance companies on all assigned accounts within expected timeframe</li>
<li>Explain hospital regulations with regard to methods for payment of accounts and maintains complete working knowledge of insurance regulations and hospital insurance contracts</li>
<li>Identify and report underpayments and denial trends</li>
<li>Analyze, identify and resolve issues causing payer payment delays; Initiate appeals when necessary</li>
<li>Manipulate excel spreadsheets and communicate results</li>
<li>Meet and maintain daily productivity and quality standards established in departmental policies</li>
<li>Act professionally, cooperatively and courteously with patients, insurance payors, co-workers, management and clients</li>
<li>Maintain confidentiality at all times</li>
<li>Other duties as assigned</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 <ul>
<li>High School Diploma or equivalent required</li>
<li>Medical Billing and Coding certification preferred, but not required</li>
<li>Experience in Hospital/Facility billing required</li>
<li>2-3 years’ experience in insurance collections, including submitting and following up on claims</li>
<li>Basic knowledge of healthcare claims processing including: ICD-9/10, CPT and HCPC codes, as well as UB-04</li>
<li>Ability to use various workflow system and client host system such as STAR, SMS, EAGLE and EPIC, as well as other tools available to them to collect payments and resolve accounts</li>
<li>Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies</li>
<li>Understanding of government, Medicare and Medicaid claims</li>
<li>Proficiency with Microsoft Office Suite including Excel and Word</li>
<li>Basic math and typing skills</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
<li>Gracious and welcoming personality for customer service interaction</li>
</ul>
Working Conditions
 <ul>
<li>Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Patient Account Representative

Job Purpose
 The Credit Management Representative is responsible for all elements of Credit Balance Management which include but is not limited to: Triaging patient and insurance credit balance to determine root cause, correcting contractual/manual adjustments, identifying overpayments and creating refund requests including appropriate documentation to support refund, identifying posting/payer trends and communicating to management for resolution.
 
Duties and Responsibilities
 <ul>
<li>Perform credit balance management for multiple clients</li>
<li>Review daily credit balance work list to imitate research of credit balance accounts</li>
<li>Research, identify root cause, and resolve patient accounts including but not limited to posting errors, insurance overpayments, patient overpayments, and/or system issues</li>
<li>Prepare and submit refund requests as appropriate obtaining all pertinent back-up data including EOBs, insurance company correspondence, refund letter of explanation and explanation of reimbursement from practice management system.</li>
<li>Correct all misapplied contractual adjustments</li>
<li>Prepare spreadsheets for payers regarding special projects involving erroneous refunds and payer retractions</li>
<li>Review payer refund request letters and take appropriate action to resolve and respond timely.</li>
<li>Maintain WQ’s assigned to ensure accounts are worked in a timely manner.</li>
<li>Identify trends and escalate to supervisor</li>
<li>Adhere to unique client specific assigned workflows & tasks</li>
<li>Collaborate effectively with co-source partners, and other functional teams supporting the business.</li>
<li>Responsible for retrieving EOB’s to post payments & denials</li>
<li>Uses the MCX workflow system, client host system, payer websites and other tools available</li>
<li>Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.</li>
<li>Meets and maintains daily productivity standards established in departmental policies</li>
<li>Adheres to the policies and procedures established for the client/team</li>
<li>Always maintain confidentiality</li>
<li>Maintain a professional attitude</li>
<li>Other duties as assigned by the management team</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 <ul>
<li>High School diploma or equivalent required</li>
<li>1-year experience in insurance collections, credit balance management and or payment posting</li>
<li>1-3 years experience in Physician/Professional billing</li>
<li>Working knowledge of the insurance follow-up process with the understanding of the fundamental concepts in healthcare reimbursement methodologies</li>
<li>Understanding an EOB and what the remarks or denials mean</li>
<li>Working knowledge of the insurance follow-up process with the understanding of the fundamental concepts in healthcare reimbursement methodologies</li>
<li>Basic knowledge of healthcare claims processing including ICD-10, CPT, and HCPC codes</li>
<li>Ability to work well individually and in a team environment.</li>
<li>Proficiency with Microsoft Office</li>
<li>Strong communication skills/oral and written</li>
<li>Strong organizational skills</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
<li>Gracious and welcoming personality for customer service interaction</li>
</ul>
Working Conditions
 <ul>
<li>Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Credit Management Representative

Job Purpose
 The Team Lead, Patient Access will be the subject matter expert for insurance verification, registration edits, referrals, and authorizations. The Team Lead, Patient Access will support the Supervisor in the fulfillment of their responsibilities as well as support the team at the rep level including, reports, analytics, productivity, quality, daily monitoring, facilitating daily huddles, projects, and providing direction that aligns/supports departmental and associate targets and goals. In addition, this role must coordinate the training, ramp up training schedule, and mentorship for new hires that are onboarding onto the team.
 
Duties and Responsibilities
 <ul>
<li>Works effectively with insurance companies to obtain/verify pre-certification/ authorization for services</li>
<li>Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company</li>
<li>Faxes to pre-certification request form to insurance company</li>
<li>Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures</li>
<li>Verifies medical insurance information and documents in scheduling/registration modules</li>
<li>Accurately enters and updates patient data, and other general data, into the computer system</li>
<li>Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics</li>
<li>Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports</li>
<li>Demonstrates knowledge of varied managed care insurance and regulatory guidelines</li>
<li>Meets and maintains daily productivity/quality standards established in departmental policies</li>
<li>Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts</li>
<li>Adheres to the policies and procedures established for the client/team</li>
<li>Communicate effectively with physician offices and patients.</li>
<li>Place outbound call to patients with precertification notification.</li>
<li>Work independently from assigned work queues</li>
<li>Always maintain confidentiality</li>
<li>Maintain a professional attitude</li>
<li>Other duties as assigned by the management team</li>
<li>Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</li>
<li>Understand and comply with Information Security and HIPAA policies and procedures at all times</li>
<li>Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</li>
</ul>
Qualifications
 <ul>
<li>High school diploma or equivalent required</li>
<li>Preferred experience in a Team Lead or coordinator role</li>
<li>Medical terminology knowledge required</li>
<li>Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations</li>
<li>Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere</li>
<li>Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes</li>
<li>Ability to work well individually and in a team environment</li>
<li>Strong organizational and task prioritization skills</li>
<li>Proficiency with MS Office. Must have basic Excel skillset</li>
<li>Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred</li>
<li>Strong communication skills/oral and written</li>
<li>Strong organizational skills</li>
<li>Strong interpersonal skills, ability to communicate well at all levels of the organization</li>
<li>Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</li>
<li>High level of integrity and dependability with a strong sense of urgency and results oriented</li>
<li>Excellent written and verbal communication skills required</li>
<li>Gracious and welcoming personality for customer service interaction</li>
</ul>
Working Conditions
 <ul>
<li>Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.</li>
<li>Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</li>
<li>Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.</li>
<li>Work Environment: The noise level in the work environment is usually minimal.</li>
</ul>
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Team Lead, Patient Access

Join Med-Metrix and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Med-Metrix

About Company

Patient Account Representative

Credit Management Representative

Team Lead, Patient Access