Patient Account Representative II,
Stanford Healthcare –
Collect and follow up on all accounts assigned prior to, during, or after admission and discharge. Communicated financial policies to all patients.Verified, researched, and completed all paperwork to billed Medicare and Medicaid claims for reimbursement.Served as patient advocate during the entire cycle of the account through telephone, mail, and research efforts. Medicare Collector/Billing.Working reports for Credit balances, refunds, bad debt, and IME billing. Re-billed Inpatient/Outpatient claims, updated insurance information.Work (RTP) Return to provider claims and issues using resources and DDE/FSS Medicare/Medicaid GAMMIS system. Contact commercial and government payers regarding underpaid and denied claims as well as contacting patients regarding claim issues.Handle correspondence from insurance companies regarding billing questions, billing issues, and medical claim denials. Identify and correct any coordination of benefit problems identified on patient accounts. Process refund requests for insurance overpayments and patient overpayments and confirm claim underpayments/overpayments by analyzing the insurance explanation of payments and insurance contracts.Identify authorization, cash posting, and registration errors on patient accounts and route to the appropriate department for correction. Submit unfilled or corrected UB04 and CMS 1500 claims by utilizing Quadax/Xpeditor software. Performed and facilitated claims processing with third party payers for coordination of benefits. Managed claim denials by contacting clinical department, patient, payor or fiscal intermediary by phone, email or appropriate websiteInitiated appeals on denied hospital claims requiring detailed research for claim resolutionCommunicated to and advised appropriate staff of changing payor policies, denial trends and policiesMaintained patient accounting files requiring detailed notes, manual logs and on-line functions for submission to third party payers assisted with claim edits.
Reimbursement Counselor/Case Manager,
Lash Group –
medical and pharmacy benefit insurance verifications and investigations for
commercial and government payers. Builds relationships with patients,
caregivers, HCSs, and Sales Team to collect / share information and coordinate
participation in the program. Communicates with insurance companies, and
third-party vendors to collect / share information and coordinate participation
in the program. Researches available disease-specific information in the
assigned region: events, activities, resources, support groups, etc. Handles
complex calls in a call-center environment. Communicates with internal and
external departments to facilitate coordination of information / resources.
Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required
and as per policy. Strictly adheres to Standard Operating Procedures (SOPs).
Accurately interprets patient insurance, prescription and other health-related
documentation, as needed. Validates and enters prescription orders, as
Completes casework in a timely manner with consistent follow-up as the
accountable case manager. Maintains patient confidentiality. Advocates on
behalf of the patient to problem-solve any issues or obtain necessary information.
Understands prescription drug benefit management techniques including
Formularies, Prior Authorizations, etc. Performs clerical and administrative
functions such as mailing and faxing correspondence, data entry, scheduling,
etc. Acquire/Exhibit/Maintain subject matter expertise in the area of the liver
disease, including but not limited to the condition, treatment, community of
patients and caregivers, activities and events offered throughout the country,
etc., to ensure staff is providing the appropriate support / service(s).
Medical Assistant/Medical Billing,
Gastroenterology Consultants of the Peninsula –
delinquent accounts by establishing payment arrangements with patients;
monitoring payments; following up with patients when payment lapses occur.
Utilizes collection agencies and small claims court to collect accounts by
evaluating and selecting collection agencies; determining appropriateness of
pursuing legal remedies; testifying for the hospital in court cases. Maintains
medicare bad-debt cost report by tracking billings; monitoring collections;
compiling information. Initiates claims against estates by monitoring deaths
and unpaid accounts; informing legal department to act on probate and estate
issues; following-up with clerk of court. Secures outstanding balance payments
for care of hospital employees by establishing payroll deductions; obtaining
signatures for automatic transfers. Secures obstetrical payments by
interviewing and obtaining information from pre-delivery patients; establishing
payments due prior to delivery; sending monthly statements. Maintains work
operations by following policies and procedures; reporting compliance issues.
Maintains quality results by following standards. Protects hospital's value by
keeping collection information confidential. Updates job knowledge by
participating in educational opportunities. Serves and protects the hospital
community by adhering to professional standards, hospital policies and
procedures, federal, state, and local requirements and standards. Enhances
billing department and hospital reputation by accepting ownership for accomplishing
requests; exploring opportunities to add value to job accomplishments. Report
to clinical coordinator or practice administrator. Perform nursing procedures
under supervision of physician or physician assistant. Assist physician and
physician assistant in exam rooms. Escort patients to exam rooms, interviews
patients, measure vital signs, including weight, blood pressure, pulse,
temperature, and document all information in patient's chart. Give instructions
to patients as instructed by physician or physician assistant. Ensure all
related reports, labs and information is filed is available in patients'
medical records prior to their appointment. Keep exam rooms stocked with
adequate medical supplies, maintain instruments, prepare sterilization as
required. Take telephone messages and provide feedback and answers to
patient/physician/pharmacy calls. Triage and process messages from patients and
front office staff to physicians and physician assistants. Maintain all logs
and required checks (i.e. refrigerator temperatures, emergency medications,
expired medications, oxygen, cold sterilization fluid change, etc.). All other
duties as assigned by clinical coordinator or practice administrator.
Adecco Temp. Agency/Genentech Inc. –
South San Francisco
Receives and coordinates all referrals to
include notification of insurance providers for prior authorization and
services covered. Responsible for the review of daily logs and notes from Case
Managers to assure continuity of care, documentation of nursing process,
appropriateness of intervention/action and timeliness of documentation. Using
discretion and independent judgment in handling patent or physician complaints
received documents and forwards to appropriate administrative staff.
Responsible for maintaining supply inventory as well as daily distribution of
supplies to field staff. Maintains log and any reports essential for
appropriate billing and reorder process. Communicates with Branch Manager any
information received from physician, patent or employees about the patents care
or needs. Primary contact for receiving phone calls to the branch office. Takes
physician orders by phone, documents, notifies appropriate Case Manager and
adjusts schedules accordingly as indicated. Files all office records as
necessary. Provide direct patient care on an as-needed
basis, as assigned by Branch Manager.
Seton Medical Center –
Registration specialists help
assign beds and carry out procedures to admit, transfer, or discharge patients.
Input patient information into a computer system and verify necessary physician
referrals and insurance authorizations. All tasks must be performed with close
adherence to both hospital rules and regulatory compliance. Help ensure clients
properly fill out and sign all relevant insurance and hospital release forms.
Explain financial options to patients. Collection and processing of payments.
Maintain accurate record of payments received and provide patients' insurance
companies with the proper paperwork that reflects all related transactions.
Maintain and balance a cash drawer as well.
UC San Francisco Hospital –
patient information by collecting demographic information from a variety of
sources; interacting with registration areas and physicians' offices;
retrieving information from automated printer. Maintains master patient index
by completing assigned portion of daily audit trail; corrects and communicates
problems according to established procedures. Initiates the medical record by
creating and processing
patient care record folder. Maintains record availability by processing charts
into the department; using chart mark-off procedures; facilitating chart
location activities. Retrieves medical records by following chart-out
procedures; documenting reasons charts cannot be retrieved for statistical and
follow-up purposes. Delivers charts to assigned areas of the hospital by
following established routing procedures. Keeps health care providers informed
by communicating availability or unavailability of the record. Maintains
quality results by following hospital standards. Maintains continuity of work
operations by documenting and communicating actions, irregularities, and
continuing needs. Maintains patient confidence by keeping patient records
information confidential. Enhances medical records and hospital reputation by
accepting ownership for accomplishing new and different requests; exploring
opportunities to add value to job accomplishments.