Remote- Medical Collections- CST, EST

Overview

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.

Responsibilities Include duties as assigned in a professional demeanor, interacting with insurance plans, patients, physicians, attorneys and team members as needed. Basic computer skills to navigate system applications, access payer websites to resolve accounts, and document actions clearly in the patient accounting system. Maintain department daily productivity goals while meeting quality standards. Identify and communicate issues including system access, payor behavior, account workflow inconsistencies or other insurance collection opportunities.

Provide support for team members when absent or backlogged.

• Researches each account using company patient accounting applications and internet resources. Conducts appropriate account activity on uncollected balances with third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolutions to bring in revenue with minimal re-work. Update plan IDs, adjust patient or payor demographic/insurance information, notate account in detail, identify payor issues and trends, and resolve re-coup issues.
  
  Request additional information from patients, medical records, and other needed documentation. Review contracts, identify billing or coding issues, and request re-bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about timely account resolution or open a dispute record for further research. Maintain desk inventory to remain current without backlog while meeting productivity and quality standards.
• Perform special projects and other duties as needed; document findings and communicate results.
• Recognize potential delays and trends with payors and respond to avoid A/R aging. Escalate payment delays or problem aged accounts to Supervisor in a timely manner.
• Participate in meetings, training seminars and in-services to develop job knowledge. Respond timely to emails and telephone messages as appropriate.
• Ensure compliance with State and Federal laws and 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill and/or ability required.

• Thorough understanding of the revenue cycle process from patient access through Patient Financial Services procedures and policies
• Intermediate skill in Microsoft Office (Word, Excel)
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently
• Clear and professional communication (oral and written)
• Strong interpersonal, analytical and critical thinking skills
• Ability to make sound decisions and understand Commercial, Managed Care, Medicare and Medicaid collections
• Intermediate knowledge of Managed Care contracts, contract language and government payor requirements
• Familiar with HMO, PPO, IPA, Capitation; understanding of EOB and hospital billing forms (UB04, HCFA 1500)
• Ability to problem solve, prioritize duties, and follow through on tasks

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

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

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…