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Title:  Patient Accounts Representative II/ Appeals and Denials

Division:  Patient Business Services
Schedule:  Monday-Friday, 8:00 a.m.-5:00 p.m.
Work Location:  Greenway Plaza, Houston, TX
Salary Range:  $30,962-$39,000
FLSA Status:  Nonexempt
Requisition ID:  4723
Summary

The Patient Accounts Representative position requires an experienced collector that understands AR follow up.The collector should have knowledge of how to appeal a denied claim and check status of a claim by payer website or placing a telephone call to the payer.

Job Duties
  • Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients.
  • Calls insurance companies or access payer website for claim status, appeal status on denied claims and payment reimbursement.
  • Investigates & resolves denials, unpaid accounts, partially paid accounts and requests for information, including appeals.
  • Identifies patients accurately and assigns the patient a unique identification number.
  • Secures patient accounts in order to maximize reimbursements in a customer service oriented fashion.
  • Maximizes the efficiency and accuracy of the collection process by up-front collection and maintaining bill hold reports.
  • Provides documentation in the patient’s charts of general consent, information release, advanced care directives, and other requirements.
  • Follows up on outstanding accounts and make proper notations (updating insurance information, using correct activity codes) in the Epic system.
  • Resolves any unusual denials, low payments, or requests for information, including appeals.
  • Reviews invoices to verify payments and contractual adjustments.
  • Drafts letters to the insurance company’s Medical Review Board to expedite payment.
  • Evaluates if payments were made according to contract.
  • Updates patient information and file medical claims with correct information, via electronic or paper submission.
  • Provides guidance and technical work direction to less experienced Patient Account Representatives.
Minimum Qualifications
  • High school diploma or GED.
  • Three years of relevant experience.

 

 

 

 

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

 4723