Sr. Patient Accounts Representative; H

Senior Patient Accounts Representative

Department of Neurological Surgery, University of Miami – Miami, FL.

The Senior Patient Accounts Representative ensures that patient demographic information is accurate and that funding source is billed and collected appropriately. The role uses advanced knowledge of billing procedures and coding expertise to assist management in the training of staff and in assuring compliance with protocols and regulations.

• Submits claims to insurance companies and follows up on outstanding claims.
• Processes, remits, and posts payments to patients’ accounts.
• Reconciles monthly charges, identifies any errors, and researches coverage policies.
• Assists patients with insurance and billing questions.
• Sets up budget plans on outstanding accounts, mails copies of budget agreements to patients, monitors compliance, and follows up on any payment delinquencies.
• Receives and reviews patient, insurance, and attorney correspondence, researches issues, and provides written responses.
• Enters all returned mail and stale checks in the database and researches to acquire updated address information to reprocess items.
• Recommends policy and procedural changes to management for review as needed.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

• High School diploma or equivalent.
• Minimum of 3 years of relevant experience.
• Skill in completing assignments accurately and with attention to detail.
• Ability to analyze, organize and prioritize work under pressure while meeting deadlines.
• Ability to process and handle confidential information with discretion.
• Proficiency in computer software (Microsoft Office).
• Ability to communicate effectively in both oral and written form.

• Responsible for obtaining authorization for all elective scheduled procedures.
• Obtains necessary authorizations, pre-certifications, and referrals.
• Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.
• Works with physician nurse to complete spinal forms for insurance plans as necessary.
• Obtains CPT codes from coder to submit authorization requests.
• Contacts patients’ families or physicians’ offices to obtain missing insurance information.
• Verifies insurance contracted with Physician and Facility.
• Verifies insurance eligibility and facility contracts of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.
• Notifies patients of liabilities prior to date of service and collects funds.
• Collaborates with scheduling departments to identify add-on patients.
• Deploys critical thinking while responding to a variety of technical issues from patients, physicians and employees via phone, email, web messages, fax, or email.
• Works independently and deals effectively with stress due to heavy workload and the handling of complex patient inquiries.
• Recommends new approaches to management for enhancing performance and productivity.
• Outstanding interpersonal skills with a commitment to service excellence.
• Able to handle multiple tasks, software systems, and technologies simultaneously.
• Notifying patient of financial responsibility (out of pocket, deductible, co‑insurance).
• Requesting Single Case Negotiation letters from second party once out of network authorization is approved.
• Working in conjunction with PCPs office in obtaining referrals/authorization.
• Update insurance information in UChart in a timely manner.
• Submit/communicate with 3rd party vendors by sending approvals to the corresponding facility.
• Working with international and domestic self‑pay teams in requesting quotes.
• Work with Physician, Nurse Liaison and Administrative Assistant to appeal any denial or Peer to Peer review to ensure all procedures are authorized prior to date of service.
• Set up peer to peer with health plan.
• Notifying physician of denials.
• Notifying patients of denial or pending cases >3 days prior to surgery.
• Prepare surgical package for Billing with all pertinent information including authorization.
• Ability to establish and maintain effective working relationships with patients and staff.
• Attend staff meetings.
• Answers the phone in a prompt and courteous manner, relaying messages accurately and timely.
• Other duties as assigned.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on categories protected by Federal law.