Patient Accounts Representative- Hybrid

At Boston Children’s Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we’re committed to reflecting the spectrum of their cultures while opening doors of opportunity for our team. Here, different talents, pursue common goals. Voices are heard and ideas are shared. Join us and discover how your unique contribution can change lives. Yours included.

Position Summary/ Department Summary:
In accordance with government regulations and hospital policies, provides positive and effective customer service that supports departmental, foundation and hospital operations Manages daily assignments using standardized protocols and work drivers. Ensures required demographic, insurance, referral/authorization and clinical, data is collected, verified, and communicated appropriately. Coordinates activities with specific physician offices, service sites and ancillary departments. Prepares and submits accurate insurance claims to payer within proper timeframes. Works payer scrubber and denial reports in an effective and timely manner. Ensures prompt resolution of outstanding insurance claims. Identifies trends, denials, issues impacting account resolution or workload and refers as appropriate. Maintains a basic understanding of 3rd party payer contracts.

Key Responsibilities:

• Collect, verify, and record all demographic information required for financial pre-processing of patients.
• Verify insurance eligibility utilizing available technologies, payer websites, or by phone contact with third-party payers
• Ensure that the correct insurance company name, address, plan, and filing order are recorded in the patient accounting system
• Utilize payer exception reports to update coverage / PCP information
• Contact clinical departments and PCP offices to secure referrals and enter into the patient accounting system
• Document all actions taken on account with clear and concise account notes
• Participate in process improvement opportunities
• Prepare and submit accurate insurance claims to the payer within proper timeframes. Accept, reject, and reconcile claim runs daily. Ensure prompt resolution of outstanding insurance claims
• Effectively works payer scrubber and denial reports daily
• Review claims for accuracy and correct errors as needed
• Collaborate with referral/authorization staff to resolve issues
• Update demographic and coverage information as needed
• Document all actions taken on account with clear and concise account notes and maintains billing logs as required
• Prepare reports as required. Monitor and identify trends, denial / claim errors by payer and refer as appropriate
• Maintain a thorough understanding of 3rd party payer contracts

Education:
High School diploma
Experience/Qualifications

• Previous experience in a medical billing setting, preferably on an automated system is preferred
• The ability to exchange information on factual matters. Interaction requires courtesy and tact when dealing with patients, hospital employees and third parties
• Fluency in oral and written English, with emphasis on communication skills and ability to document records

Schedule- 7:30-4 or 8-4:30 M-F. Hybrid. 1 day in person

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.