Patient Account Representative (Healthcare)

Make a difference every day at Amoskeag Health! As a Federally Qualified Health Center (FQHC) and nonprofit primary healthcare organization, we provide high-quality, affordable care to our community and ensure everyone has access to healthcare.

Join a team thats dedicated to making an impact. Our collaborative, team-based approach brings together medical providers, Behavioral Health Clinicians, Case Managers, Care Coordinators, and Community Health Workers to deliver comprehensive, patient-centered care. Ready to be a part of something meaningful?

RESPONSIBILITIES:
a) Ensures that all claims are reviewed daily and submitted electronically in a timely manner using the claims management system.
b) Reviews all claim edits/claim rejections and makes the necessary corrections ensuring compliance with all federal, state and specific commercial payer requirements.
c) Works claims in an on-hold status to ensure timely billing practices
d) Coordinates data requests with other departments in support of timely billing. (Medical Records/Intake/Provider Orders or Referral Center/Quality Review)
e) Utilizes resources available to monitor outstanding claims for assigned payers (Work Queues/Aging Reports) and ensures claim follow-up does not exceed payer filing limits.
f) Initiates re-billings, corrected claims and appeals following these specific payer requirements.
g) Documents billing activities on the patient account to assist in problem resolution within present system being utilized by Amoskeag Billing Office.
h) Identifies compliance risk and proactively recognize and rectify any issues to prevent payer audits.
i) Uses in depth knowledge of contracts and reimbursement to obtain the proper resolution.
j) Monitors assigned work to ensure billing and follow-up activities are maintained at the levels set by management.
k) Establishes independent follow up processes on accounts worked to ensure payer response.
l) Monitors and identifies claim rejections or denials for trends for the assigned payer and reports them to management.
m) Upon receipt reviews and determines the proper disposition of claims with credit balances.
n) Responsible for the daily reconciliation of charges, adjustments, and payments.
o) Reconciles overpayments from Medicare, Medicaid, Blue Cross/Blue Shield, and other third-party payments. Maintain files. Pulls copies of paid/processed claims from the file.Follow up on unpaid claims within 45 days.
p) Ensure payments posted in the system balance against amounts received/deposited.
q) Interact with clients in a positive and professional manner; sensitive in approach to discussions with clients regarding financial matters.
r) Other responsibilities as assigned by supervisor.