Job Summary This Patient Accounts Representative will be responsible to:
Prepare and submit accurate insurance claims to payer within proper timeframes.
Accept, reject, and reconcile claim runs daily. Ensure prompt resolution of outstanding insurance claims.
Effectively work payer scrubber and denial reports daily.
Review claims for accuracy and correct errors as needed.
Collaborate with referral/authorization staff to resolve issues.
Resolve claims processing issues with 3rd party payers and provides all requested information timely; engage patients and family members to resolve claim or insurance issues when needed.
Provide documentation to have claims processed and paid. Researching, preparing, and providing 3rd party payer appeals. Request account adjustments in accordance with payer contractual agreements.
Document all actions taken on accounts with clear and concise account notes and maintaining billing logs as required.
Prepare reports as required. Monitor and identify trends, denials/claim errors by payer and refer as appropriate.
Maintain a thorough understanding of 3rd party payer contracts.
Verify insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers.
Ensure that correct insurance company name, address, plan, and filing orders are recorded in the patient accounting system.
To qualify, you must have:
A high school diploma. Previous experience in a medical billing setting, preferably on an automated system is preferred.
The analytical skills to gather and interpret data in situations in which the information or problems are relatively routine.
The ability to exchange information on factual matters. Interaction requires courtesy and tact when dealing with patients, hospital employees and third parties.
The ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations is required.
The ability to work with diverse internal and external constituencies.
Excellent attention to detail, good organizational skills, ability to meet priorities within set timeframes, and ability to work as part of a team.
Part Remote/Hybrid if you live in MA, RI, NH or ME
Boston Children's Hospital offers competitive compensation and unmatched benefits including affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.