Job Summary
In accordance with government regulations and hospital policies, provides positive and effective customer service that supports departmental, foundation and hospital operations Manages daily assignments using standardized protocols and work drivers. Ensures required demographic, insurance, referral/authorization and clinical, data is collected, verified, and communicated appropriately. Coordinates activities with specific physician offices, service sites and ancillary departments. Prepares and submits accurate insurance claims to payer within proper timeframes. Works payer scrubber and denial reports in an effective and timely manner. Ensures prompt resolution of outstanding insurance claims. Identifies trends, denials, issues impacting account resolution or workload and refers as appropriate. Maintains a basic understanding of 3rd party payer contracts.

The Patient Accounts Representative will :

Collect, verify, and record all demographic information required for financial pre-processing of patients.

1. Verify insurance eligibility utilizing available technologies, payer websites, or by phone contact with third-party payers
2. Ensure that the correct insurance company name, address, plan, and filing order are recorded in the patient accounting system
3. Utilize payer exception reports to update coverage / PCP information
4. Contact clinical departments and PCP offices to secure referrals and enter into the patient accounting system
5. Document all actions taken on account with clear and concise account notes
6. Participate in process improvement opportunities

Billing and Collection:

Prepare and submit accurate insurance claims to the payer within proper timeframes. Accept, reject, and reconcile claim runs daily. Ensure prompt resolution of outstanding insurance claims

1. Effectively works payer scrubber and denial reports daily
2. Review claims for accuracy and correct errors as needed
3. Collaborate with referral/authorization staff to resolve issues
4. Update demographic and coverage information as needed
5. Resolve claims processing issues with 3rd party payers and provides all requested information timely; engaging patients and family members to resolve claim or insurance issues when needed
6. Provide documentation to have claims processed and paid. Research, prepare, and provide 3rd party payer appeals. Request account adjustments in accordance with payer contractual agreements
7. Document all actions taken on account with clear and concise account notes and maintains billing logs as required
8. Prepare reports as required. Monitor and identify trends, denial / claim errors by payer and refer as appropriate
9. Maintain a thorough understanding of 3rd party payer contracts

To qualify, you must have:

• A high school diploma
• Previous experience in a medical billing setting, preferably on an automated system is preferred
• The ability to exchange information on factual matters. Interaction requires courtesy and tact when dealing with patients, hospital employees and third parties
• Fluency in oral and written English, with emphasis on communication skills and ability to document records
• 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

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

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