Saint Luke's Health System
Patient Accounts Representative
Saint Luke's Health System, Independence, Missouri, United States, 64053
Overview
The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, entering charge demographics, troubleshooting charge related issues raised by clinic staff, responding to inbound and outbound billing calls from patients, payment posting, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues. Responsibilities
Claim Edits: Research patient billing claims to identify and correct coding/claim errors. Research patient insurance coverage to identify and resubmit claims to fix coverage denials. Research and outline documentation needed for payor organizations so that claims are processed correctly. Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc. Identify problem trends and communicate with payors for resolution to claims. Process 277 EDI transactions/rejections and work with EDI transactions. Perform payment posting corrections/adjustments and distribute payments. Enter charges accurately and work with multiple teams/departments to resolve issues. Coordinate payment plans or financial assistance as needed. Insurance Denials and Follow-Up
Research, identify errors, and correct claims denied by insurance companies. Assess claims to determine when it is appropriate to make charge adjustments, void a charge, or escalate. Write appeal letters to insurance companies and follow up on no-response claims. Address billing code issues raised by patients via customer service escalations. Research refund requests from payor organizations. Conduct preliminary audits of billing code errors before submission to the Coding team. Route complex claim denials to the team lead or appropriate medical billing team. Identify issues that can be resolved by programming software to prevent denials. Develop subject matter expertise on payor policies and communicate with provider representatives to resolve problems. Perform simple level coding, including diagnosis review, modifier applications, and some CPT code changes following process documents and payor policies. Job Requirements
Applicable Experience: 1 year Job Details Full Time Day (United States of America) The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter. Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.
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The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, entering charge demographics, troubleshooting charge related issues raised by clinic staff, responding to inbound and outbound billing calls from patients, payment posting, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues. Responsibilities
Claim Edits: Research patient billing claims to identify and correct coding/claim errors. Research patient insurance coverage to identify and resubmit claims to fix coverage denials. Research and outline documentation needed for payor organizations so that claims are processed correctly. Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc. Identify problem trends and communicate with payors for resolution to claims. Process 277 EDI transactions/rejections and work with EDI transactions. Perform payment posting corrections/adjustments and distribute payments. Enter charges accurately and work with multiple teams/departments to resolve issues. Coordinate payment plans or financial assistance as needed. Insurance Denials and Follow-Up
Research, identify errors, and correct claims denied by insurance companies. Assess claims to determine when it is appropriate to make charge adjustments, void a charge, or escalate. Write appeal letters to insurance companies and follow up on no-response claims. Address billing code issues raised by patients via customer service escalations. Research refund requests from payor organizations. Conduct preliminary audits of billing code errors before submission to the Coding team. Route complex claim denials to the team lead or appropriate medical billing team. Identify issues that can be resolved by programming software to prevent denials. Develop subject matter expertise on payor policies and communicate with provider representatives to resolve problems. Perform simple level coding, including diagnosis review, modifier applications, and some CPT code changes following process documents and payor policies. Job Requirements
Applicable Experience: 1 year Job Details Full Time Day (United States of America) The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter. Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.
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