ACCOUNT REP I- On-site

General Duties, Tasks and 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 so that assistance can be utilized to relieve backlog.
• Maintains hospital/billing systems and forms as needed for accurate billing; utilizes available resources to maintain billing compliance knowledge.
• Reviews and understands financial assistance program; 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 the billing forms and who is authorized to make changes to those codes; 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.
• Sets up self-pay and collection agency accounts; processes returned reports and documents (i.e. 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.

Education Requirements

• High School diploma / Equivalent
• Required: Associate's Degree in a related field
• PREFERRED: Healthcare Insurance / Billing minimum 1 year
• PREFERRED: Computer Skills: Strong computer skills including Microsoft Excel and Outlook

Experience Requirements

• Office / Clerical setting minimum 1 year
• PREFERRED: Healthcare Insurance / Billing minimum 1 year

Additional Skills

• Strong interpersonal, organizational and time management skills
• Excellent written and verbal communication skills, be professional, polished and articulate well
• Knowledge of criteria for Medicare, Medicaid, HMO and private insurance