JOB SUMMARY

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the following:

• Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
• Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions
• Access payer websites and discern pertinent data to resolve accounts
• Utilize all available job aids provided for appropriateness in Patient Accounting processes
• Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
• Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
• Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities
• Provide support for team members that may be absent or backlogged

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
• Intermediate skill in Microsoft Office (Word, Excel)
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently
• Ability to communicate in a clear and professional manner
• Must have good oral and written skills
• Strong interpersonal skills
• Above average analytical and critical thinking skills
• Ability to make sound decisions
• Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School diploma or equivalent. Some college coursework in business administration or accounting preferred
• 1-4 years medical claims and/or hospital collections experience
• Minimum typing requirement of 45 wpm

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
• Intermediate skill in Microsoft Office (Word, Excel)
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently
• Ability to communicate in a clear and professional manner
• Must have good oral and written skills
• Strong interpersonal skills
• Above average analytical and critical thinking skills
• Ability to make sound decisions
• Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office/Team Work Environment
• Ability to sit and work at a computer terminal for extended periods of tim

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Call Center environment with multiple workstations in close proximit