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

· No travel is required

OTHER DUTIES

Other duties as required by management.

Salary Description

$23.00 - $29.00 per hour