Patient Account Representative

We are Gateway Regional Medical Center. Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
• Comprehensive Employee Benefits: Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

Job Objective:

Under the supervision of the Director of Revenue Cycle, or designee, performs patient account insurance follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.

Duties and Responsibilities:

1. Insurance Follow-up, as assigned
   1. Review claims on-line as offered by individual payors to ensure timely processing
   2. Contact insurance carriers by phone regarding outstanding balances, as needed
   3. Resubmit claims to insurance carriers, as needed
   4. File appeals on technical denials and/or claim disputes, as needed
   5. Validate accounts for accurate payments, discounts, and contractual adjustments, correcting them, as needed
   6. Reply to insurance carrier correspondence in a timely matter
   7. Answer in-coming calls resolving insurance issues in a timely matter

1. Credit Balance Process and Review, as assigned
   1. Review all credit balance accounts for incorrect contractual adjustments, correcting them as needed.
   2. Respond in writing to insurance companies' refund requests in a timely matter to avoid inappropriate recoupments.

Non-Essential Duties:

Assist with other duties as assigned, within skill sets and abilities

Knowledge

Working knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement

Working knowledge of Managed Care contract language and interpretation

Education

High School graduate or equivalent

Experience

Minimum 1-year previous Commercial, HMO, PPO, and Workers Compensation billing and/or

Insurance follow-up experience

Will consider 2-years recent acute care hospital Business Office experience