Patient Account Representative - Medicare
- 1) When necessary, contacts patients or his/her representative to obtain correct insurance information. Enters correct information. Scans copies of insurance cards to current electronic data storage system.
2) Verify insurance coverage upon receiving new insurance information. This is done either by phone, electronically through website or hospital online insurance verification program.
4) Corrects any patient information in the computer as needed.
5) Explains hospital policies regarding financial assistance to patients when necessary.
6) Has extensive knowledge of Medicare/Medicare policies and procedures
7) Has extensive knowledge of APCs.
8) Has extensive knowledge of Medicare Advantage contracts and reviews them electronically to insure correct payment has been received.
9) Contacts any Medicare Advantage company when needed to ensure any special billing requirements.
10) Assists patients in understanding his/her insurance, Medicare or Medicare Advantage benefits.
11) Files all Medicare/Medicare Advantage plan claims electronically
12) Performs timely follow-up on all Medicare claims via CCSM, Medicare remote or by phone. Correcting claims in error.
13) Performs account follow-up and keeps it current, using appropriate follow-up codes, and thorough documentation on the account of action taken and to be taken on the account.
14) Analyze Medicare/Medicare Advantage plan remittances to ensure correct payment is received, and work denied claims.
15) Responsible for coordination of benefits insurance filing with secondary payer.
16) Responsible for insurance follow-up of secondary/tertiary claims.
17) Responsible for reporting denials from Medicare/Medicare Advantage or third party payer.
18) Work with Revenue Management, Coding, Ambulance Team and other necessary departments to obtain required information needed to bill a compliant claim, to Medicare, Medicare Advantage plans and secondary payers.
19) Attends seminars/workshops/webinars pertaining to Medicare/Medicare Advantage plan billing policies and procedures. Share learned information with all necessary personnel to include Supervisor and Co-workers or other departments.
20) Make adjustments and/or corrections to patient accounts.
21) Analyzes and monitors the UB04 manual for updates
22) Analyzes and monitors the Medicare/Medicare Advantage plan websites for Billing updates, process changes and informs necessary personnel, to included Supervisor and Co-workers or other departments.
23) Professionally and courteously makes/answers telephone calls, routes calls, or takes message(s) as appropriate.
24) Represents the hospital in court when necessary regarding collection of delinquent accounts.
25) In a professional manner, handles or refers to the appropriate department manager any meaningful complaint or comment. Also, submit complaints online using the SMH Complaint Resolution Form.
26) Reviews credit balances on a weekly basis and assists with training of other personnel who may assist with the Medicare/Medicare Advantage credit balances.
27) Responsible for working the UB Editor on a daily basis and keeping it current.
28) Monitors the 3 day window on all Medicare claims, prior to billing.
29) Update the MSP Questionnaire on any accounts in which Medicare is added. The patient must supply the appropriate answers.
30) Utilizes data storage system for optical scanning of all pertinent documentation. Scanning should be kept current on a weekly basis.
31) Utilizes electronic data storage system to review patient insurance cards or records as needed.
32) Works closely with the physician’s offices on patient demographics or insurance information if unable to locate by any other means.
33) Notify Case Management when adding a Medicare Advantage plan to anin-house patient account so pre-certification can be obtained if necessary.
34) Responsible for providing training for new staff members.
35) Work closely with other team members to ensure that all Medicare/Medicare Advantage plan billing is being done in a consistent and compliant manner.
36) Works Billing Readiness Report Daily.
37) Works Late Charge Report Daily.
38) Opens email daily and responds within a timely manner
Saline Memorial Hospital - 20 months ago