Patient Account Representative

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.

• Research each account using company patient accounting applications and internet resources that are made available. Conduct appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e‑mail, or online. Problem solve issues and create 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.

• 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.

• 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.

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

• Call Center environment with multiple workstations in close proximity.