Patient Account Representative - Medicare Specialist

📋 Description

• • As a Patient Account Representative specializing in Medicare, you will serve as a critical subject matter expert, deeply immersed in the intricacies of Medicare claims and accounts receivable follow-up. This role is designed to function as an extension of our clients' business office operations, requiring you to proactively manage and resolve outstanding account balances.
• • Your primary responsibility will involve engaging with both patients and insurance companies through incoming and outgoing calls. You will meticulously investigate account discrepancies, identify reasons for non-payment or denial, and implement effective strategies to secure timely reimbursement.
• • Adherence to all client-specific policies and procedures is paramount. You will be expected to navigate complex billing systems and insurance portals, ensuring accuracy and compliance in all your interactions and documentation.
• • A significant aspect of this role involves managing a substantial caseload, typically handling between 40 to 70 accounts per day. This requires exceptional organizational skills, efficient time management, and the ability to prioritize tasks effectively to meet daily targets.
• • You will be responsible for conducting thorough account reviews, identifying and addressing any issues related to appeals and denials. This includes understanding the nuances of Medicare and Medicaid billing regulations and processes.
• • A key function is insurance follow-up, where you will diligently track claims, follow up on outstanding payments, and resolve any rejections or re-submissions required.
• • Excellent customer service skills are essential as you will be communicating with patients to explain balances, discuss payment options, and provide clear, concise information regarding their accounts.
• • You will utilize your knowledge of billing forms, specifically UB-04 and CMS 1500, to ensure accurate claim submissions and to interpret remittance advice.
• • Completing all business-related requests and correspondence from patients and insurance companies in a professional and timely manner is a core duty.
• • You will be tasked with completing all assigned projects efficiently and effectively, contributing to the overall success of the team and client objectives.
• • Providing assistance to both clients and patients with any requested tasks demonstrates your commitment to comprehensive support.
• • You will proactively communicate any areas of concern or potential improvements to Guidehouse management, fostering a culture of continuous enhancement.
• • Researching and responding to all patient inquiries received via telephone and mail ensures that patient concerns are addressed promptly and accurately.
• • Updating patient demographic information and initiating account adjustments are necessary tasks to maintain accurate patient records and financial accounts.
• • A primary goal is to resolve account balances to zero before they are escalated to external collection agencies, thereby maximizing revenue recovery for our clients.
• • For individuals residing within 50 miles of our Lewisville, TX, El Segundo, CA, or Mitchell, SD offices, this position will operate on a hybrid schedule, requiring two days in the office and three days of remote work.
• • This role offers a unique opportunity to become a specialist in a vital area of healthcare revenue cycle management, contributing directly to the financial health of healthcare providers and ensuring patients receive clear and accurate billing information.
• • You will gain valuable experience in navigating the complexities of government healthcare payers, enhancing your professional skillset and marketability within the healthcare industry.
• • The ability to work independently and as part of a remote team is crucial, requiring strong self-discipline and effective communication strategies.
• • You will be instrumental in maintaining positive relationships with both clients and insurance payers, acting as a trusted representative of Guidehouse.
• • This position demands a keen eye for detail, a problem-solving mindset, and a commitment to achieving optimal outcomes in account resolution.