Eastern Virginia Medical School looking for Patient Account Representative at Norfolk, VA  Full Time

Performs all phases of Third Party Billing and Follow-up on services provided by EVMS Health Services clinical staff.

Responsible for the electronic and manual billing to Third Party Payers in a timely, proficient fashion and maintaining the Gateway system.
• Review all manual claim forms for accuracy prior to the claim submission.
• Understand the required attachments to claims, as they relate to CPT, ICD9, and modifier coding practices. Reviews claims for appropriate documentation attachments.
• Ensure that all carrier requirements are supported with claims submitted.
• Communicate with the EVMS Health Services clinical departments, hospitals, and patients to secure insurance data and/or medical documentation required to file claims.
• Operate the Touchworks Scan filing system to retrieve required documentation, referrals, and/or other pertinent data to file claims.
• Review IDX claim edit lists to make the necessary corrections to data input errors or missing information.
• Post the “insurance billed” paycode to all manual filed claims.
• Post the “Appeal Sent” paycode to all appealed claims.

Insurance Follow-up functions:

• Responsible for the timely follow-up, account research, and resolution of outstanding Third Party claims.
• Maintain an IDX paperless collection system (PCS) workfile, as assigned by the Insurance Department Supervisor.
• Utilize the PCS tickler system to follow through on the carrier’s promise to pay claims.
• Identify and have corrections made to any CPT/ICD9/Modifer coding error that prohibits the claim(s) from the final adjudication process.
• Coordinate the exchange of insurance information with the EVMS Health Services clinical departments to expedite claim processing.
• Identify appropriate adjustments to patient accounts for submission to the Senior PAR or the Insurance Department Supervisor.
• Prepare insurance claim forms and/or tracers on unpaid invoices in a timely fashion.
• Handle incoming calls from the insurance carriers and respond to their requests in a timely fashion.
• Other duties as assigned.

High school diploma or GED and minimum of one year of medical office experience required or must have completed a medical billing/coding program. Experience in ICD-9&1CD-10/CPT coding is required. Customer service oriented individual is required.