Patient Services Representative

• Responsible for all patient accounts receivable functions as assigned
• Reconcile, research, correct and submit third party claims and resubmit errors or denied claims
• Communicate with insurance companies and government payers to resolve claim issues and ensure payment
• Research and correct ICD 9, CPT coding, modifiers, revenue coding, occurrence codes and value codes as appropriate
• Collaborate with the Income Support Division and the Medical Assistance Division in regards to eligibility for Medicaid
• Interview and approve patients for UNMH charity programs
• Provide customer service to patients by researching billing issues with various departments and resolving the issues
• Reconcile remittance advices and patient accounts and resolve discrepancies
• Ensure adherence to Hospital sand departmental policies and procedures
• CLAIMS - Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers
• CLAIMS - Reconcile and review remittances
• research as necessary to determine proper accounts
• research and obtain correct information
• complete remittance process
• DENIALS - Follow up on claims denials
• contact appropriate party to research, coordinate and justify needed information
• make appropriate corrections, obtain approvals and resubmit claims denials for payments
• appeal denials through the payer required appeals process
• FINANCIAL ASSISTANCE - Interview patients and complete the application process for State/Government programs
• maintain MOSAA certification with the State
• interview and approve patients for UNM Hospital charity and discount programs
• COLLECTIONS - Follow up on the collection of patient accounts, contact appropriate party (third party payers, other hospitals, patients) to obtain needed information
• make appropriate corrections
• obtain approvals and resubmit claim for payment
• CLAIMS - Research unpaid claims
• contact patients to obtain necessary information to assist with claims process
• secure payments or negotiate payment plans
• CASH - Reconcile and complete cash reconciliation reports
• balance and post payments, contractual allowances, and denials
• CREDIT - Research, resolve and reconcile credit balances to include processing the refund request or take back with a payer
• COORDINATION - Work with various University Hospital departments to obtain additional information regarding services rendered to include correct coding and documentation
• TRAINING - Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
• COMMUNICATION - Handle patient inquiries, complaints and customer service issues by phone, in person or via the email
• research and resolve the issue
• DATA - Perform data entry and research using various hospital system programs
• PATIENT ACCOUNTING - Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats
• DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
• CUSTOMER RELATIONS - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees

• High School or GED Equivalent
• 2 years directly related experience

Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, Vietnamese, or Navajo