Overview
Patient Resolution Specialist Remote Jobs in New Jersey, USA at Med-Metrix
Posted Tuesday, February 18, 2025 at 5:00 AM
Job Purpose
The Patient Account Representative is responsible for collections, account follow up, and billing allowance posting for the accounts assigned to them.
Duties and Responsibilities
Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax, or websites.
Review and update all patient and financial information accurately as given.
Verify that information is accurate as to individual or insurance company responsible for payment of bill.
Monitor all billings for accuracy, updating any that contain known errors.
Monitor Medicaid/healthy options coupons to assure services are billed within expected time frames.
Bill all hospital services to primary insurer or patient correctly and within expected timeframe.
Follow up with insurance companies on all assigned accounts within expected timeframe.
Explain hospital regulations with regard to methods for payment of accounts and maintain complete working knowledge of insurance regulations and hospital insurance contracts.
Identify and report underpayments and denial trends.
Analyze, identify, and resolve issues causing payer payment delays; initiate appeals when necessary.
Manipulate excel spreadsheets and communicate results.
Meet and maintain daily productivity and quality standards established in departmental policies.
Act professionally, cooperatively, and courteously with patients, insurance payors, co-workers, management, and clients.
Perform special projects and other duties as needed by the management team.
Maintain confidentiality at all times.
Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Qualifications
High School Diploma or equivalent required.
Medical Billing and Coding certification preferred, but not required.
Experience in Hospital/Facility billing required.
2-3 years’ experience in insurance collections, including submitting and following up on claims.
Basic knowledge of healthcare claims processing including: ICD-9/10, CPT, and HCPC codes, as well as UB-04.
Ability to use various workflow systems and client host systems such as STAR, SMS, EAGLE, and EPIC, as well as other tools available to collect payments and resolve accounts.
Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies.
Understanding of government, Medicare, and Medicaid claims.
Proficiency with Microsoft Office including Excel and Word.
Ability to work well individually and in a team environment.
Strong organizational, communication, and written skills.
Basic math and typing skills.
Working Conditions
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals, and telephones; extend arms; kneel; talk and hear.
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
Work Environment: The noise level in the work environment is usually minimal.
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state, or local law.
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Title: Patient Resolution Specialist Remote
Company: Med-Metrix
Location: New Jersey, USA
Category: Healthcare (Healthcare Administration, Medical Billing and Coding, Medical Office), Administrative/Clerical (Healthcare Administration)
