Description
AIM OF THE POSITION
The Patient Advocate Representative follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner.
POSITION WITHIN THE ORGANIZATION
Reports to Reimbursement Supervisor
Cooperates with all departments across the organization
Organizes activities with Customer Care, Sales, Commercial and external vendors
Participates in:
Department meetings
Project meetings
Working groups
Project groups
Requirements
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.
- Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
- Processes and follows up with patients for copays and deductible amounts due.
- Contacts clients to obtain medical records as needed for submission of a medical appeal or
payer's review of a claim.
- Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
- Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Manager.
- Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Manager.
- Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
- Interfaces with insurance company representatives, doctor's offices and hospitals regarding schedule of services and billing inquiries.
- Assists department director in the development of new procedures and systems to enhance productivity.
- Provides account information to the sales force as needed.
The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.
KEY CONTACTS
Internal
o This position may interface with all departments within the company.
External
o External Vendors
EDUCATION AND EXPERIENCE REQUIREMENTS
EDUCATION
- High school diploma or general education degree
EXPERIENCE
- 3+ years related experience
KNOWLEDGE, SKILLS AND ABILITIES (KSA'S)
Specific Knowledge Required:
Knowledge: Comprehension of a body of information acquired by experience or study.
Skill: A present, observable competence to perform a learned activity.
Ability: Competence to perform an observable behavior.
- Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)
- Must be able to work in a fast-paced environment
- Must have strong organizational skills and attention to detail
- High degree of accuracy
- Manage multiple tasks independently
- Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication
BEHAVIOURAL COMPETENCIES/DESIRED SKILLS
- Excellent problem resolution
- Excellent customer service skills
- Outside-the-box thinker
- PRIVACY NOTICE: To review the California privacy notice, click here: https://agendia.com/privacy-policy/
- Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.
WORKING ENVIRONMENT
Establishes ADA (Americans with Disabilities Act) requirements
ENVIRONMENT/SAFETY/WORK CONDITIONS
Working conditions (inside or outside the office).
- General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Maintains a clean, neat, and orderly work area.
- Adheres to Department Specific Safety Guidelines.
- Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.
TRAVEL
OTHER DUTIES
Other duties as required by management.