Patient Accounts Representative - Insurance

Department: Patient Accounting

Position Status: 1.0 (80 hours)

Hours: Monday-Friday 8am-4:30pm

95% remote once trained (training will be done in office).

Benefits include

• Health, Dental, and Vision Insurance
• Employee Health Clinic (health +): Our health+ clinic provides office visits and prescription medications for little to no cost to Alomere Health employees and their dependents who are on a medical insurance plan
• Retirement Savings (401(k)) - All eligible employees of Alomere Health are automatically enrolled. All eligible employees are able to contribute on a pre-tax and/or post-tax basis and Alomere Health matches 100% up to 6% of employee's contributions.
• Please see more details about our benefits here: alomerehealth.com/careers

Position Objective

The Patient Accounts Representative - Insurance is responsible for all aspects of the Insurance position related to the workflow of the department, including customer service and working with Insurance companies to resolve claim issues and patients to resolve billing questions. It is essential that the accounts receivable be kept as low as possible, therefore, it is of utmost importance that the Accounts Representative is as current as possible at all times in terms of claim processing and follow-up of lagging payments.

Essential Responsibilities

Patient Account Services (Insurance) Service Delivery

• Working primary and secondary claim edits in Software for the Clinic/Hospital and also our Clearing House
• Resolve insurance denials, process late changes, follow-up on unpaid claims
• Prepare and submit hospital claims and clinic claims to third-party insurances either electronically or by hard copy billing
• Maintain close working relationships with the Coding departments in verifying coding, documentation and billing regulations
• Resubmit claims with corrections and/or additional documentation to support the level of care
• Keep updated on all third-party billing requirements and changes for insurance types within the area of responsibility
• Work with facilities to resolve overlapping or denial issues on Hospital/PBB billing issues
• Assist with Patient Access/Admitting staff when they call with questions on the different types of insurance and be able to answer them fluently
• Respond to patients questions to resolve billing questions and concerns
• Forward unresolved issues to the appropriate party and document all phone calls electronically

Other Responsibilities

• Perform all other related duties as assigned in a professional and responsive manner
• Demonstrate the ability to use relevant equipment
• Support, understand, and promote Alomere Health’s mission, vision, values, policies and procedures
• Ability to meet the work schedule requirements with flexibility dependent upon the needs of the department
• Foster respectful working relationships with professional colleagues, patients, families, and general public regardless of age, gender, lifestyle, culture, beliefs, race, socioeconomic class, or ability

Required Qualifications

• High school diploma or Equivalent

Preferred Qualifications

• Medical Administrative Assistance Program or Equivalent Experience

Knowledge, Skills and Abilities

• Knowledge of a 1500 form and a UB form
• Ability to identify and process insurance company and self-pay refunds when needed
• Ability to read an Explanation of Benefits and work on solving COB claims
• Knowledge of navigating insurance websites to verify eligibility, adjudication information and coverage issues pertaining to a specific insurance company
• Ability to read electronic RTE’s that come back from the insurance companies
• Knowledge of Provider Based Billing
• Understanding and ability to apply HIPPA rules and regulations

Union Position: No