ACCOUNT REP I- Mon-Fri 8:00am-4:30pm

About the Role

The Account Rep is responsible for providing outstanding customer service while performing a variety of clerical duties related to receiving, verifying, processing, and recording insurance and patient payments. This role also includes business office secretarial duties such as answering patient inquiries and questions regarding patient payments.

Responsibilities

• Ensures insurance claims are billed through the billing system after appropriately coded; reviews billing system errors and fixes prior to sending claims; sets up secondary claims to bill or notify appropriate biller for billing.
• Determines appropriate payment plan option(s) requested by patient based on income level; demonstrates good judgment on patient's reported income level in determining if more documentation is necessary and collects required documentation as needed.
• Accurately posts insurance payments; bills self-pay balances; sets up self-pay balance to go to agency per policy if no payment plan is set up; reviews and resolves billing conflicts with agency.
• Documents pertinent billing notes and patient communications in hospital billing systems to reflect accurate account history; explains receipting and insurance billing processes and reads account details to patients.
• Processes status claims for follow-up before EOB is received; reviews AR for follow-up on accounts; follows up on insurance in a timely manner to meet or exceed department policy standards; reports backlogs immediately to supervisor.
• Monitors and updates hospital/billing systems and forms as needed for accurate billing; utilizes available resources to maintain billing compliance knowledge.
• Reviews and understands financial assistance programs; refers patients to other assistance agencies as appropriate; evaluates likelihood of payment from other payers.
• Reviews and understands DRGs, HCPCS, CPT, and ICD codes and their purpose on billing forms; works with Home Health to resolve CPT/diagnosis code conflicts; informs supervisor as appropriate.
• Prepares files, tracks, and follows up on financial assistance packets, liens, estates, and collection agencies in a timely manner.
• Submits self-pay and collection agency accounts timely; processes returned reports and documents (e.g., collection agency reports and bad checks).
• Prepares billing reports requested by supervisor and supports audit requests for documents.
• Ensures timely and accurate data exchanges between EMR and outsourced agencies.
• Complies with all established safety procedures to ensure a safe environment for patients, visitors, and staff.
• Participates in performance improvement activities.
• Performs other duties as assigned.

Requirements

• High School diploma or equivalent (required).
• Associate's Degree in a related field (preferred).
• Minimum 1 year of office/clerical experience (preferred).
• Minimum 1 year of healthcare insurance/billing experience (preferred).

Skills

• Strong computer skills, including Microsoft Excel and Outlook.
• Strong interpersonal, organizational, and time management skills.
• Excellent written and verbal communication skills; professional, polished, and articulate.
• Knowledge of criteria for Medicare, Medicaid, HMO, and private insurance.

FLSA Classification: Non-Exempt