Patient Account/Customer Service Rep-Self Pay and Bad Debt

About the role

The Patient Account Representative – Self Pay and Bad Debt coordinates, monitors, reports and facilitates the accurate reporting and maintenance of the outsourced accounts in a self-pay classification and bad debt accounts transferred to outside collection agents. Balances to inventories and prepares monthly activity reporting.

Responsibilities

• Posts manual cash deposits on a daily basis as assigned.
• Receives and posts and reconciles assigned payment batches to the appropriate patient account from the remittance advice or checks using the appropriate payment/adjustment code to insurance.
• Reviews daily automated posting as assigned by payer and assures the payment batches are reconciled to the account postings.
• Reviews cash posting error reporting and completes any appropriate corrections such as financial class changes, updating payer information, and/or changing the priority of the payer to accounts to ensure payments are posted accurately.
• Insures contractual and other approved adjustments are posted timely and accounts are reconciled and the account balances are correctly reflected in the appropriate payer responsibility in the Patient Accounting System.
• Researches and codes each payment receipt accurately, thoroughly and timely according to the Payment Posting procedures. Documents payment information on accounts in the Patient Accounting host system.
• Batches cash receipts, balances them to the deposit, and maintains the batch control log of payments daily.
• Sorts the mail received in the deposit and forwards any non-payment posting mail appropriate.
• Insures zero (0) payment and/or informational “nonpayment requests” are timely and accurately forwarded/assigned to the account follow up team for additional follow up and/or denial resolution.
• Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
• Performs routine audits of assigned individual accounts to resolve all discrepancies in account balances – credit balances, underpayments, inaccurate contractual allowances and performs necessary actions to resolve the account balance.
• Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.
• Reconciles imports and return account activity with the vendors. Reviews differences and works with vendors to resolve.
• Reviews and audits billings from outsourced activities and recommends for payment or payment with changes.
• Reconciles recoveries of Bad Debt on a monthly basis.
• Works self-pay credit balances and resolves.
• Prepares Medicare Bad Debt schedule and maintains on a monthly basis.
• Gathers and stores collection efforts backup and proof to insure bad debt reimbursement.
• Acts as hospital liaison for all outsourced account activity – enters and updates account information as received and routes for appropriate action – rebill, adjustment, financial assistance, closure, etc.
• Produces monthly reporting of outsourced activities performance. Compares to prior periods and established benchmarks.
• Maintains work lists at all sources and insures expeditious resolution. Works with other departmental representatives in resolve.
• Reports unresolved issues and concerns impeding the collection process and to ensure successful account resolution.
• Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.
• Sets up and maintains patient files.
• Handles telephone information with courtesy, accuracy, and respect for confidentiality; receives information and distributes messages appropriately.
• Communicates appropriately with patients and staff and responds to requests for assistance promptly.
• Provides accurate communication in verbal, nonverbal and written form.
• Listsens effectively.
• Communicates effectively with supervisor, including but not limited to changes of operation. Reports to supervisor regularly on the status of ongoing projects.
• Aids in the orientation of new staff.
• Follows proper chain of command appropriately to resolve problems and concerns.
• Treats patients and their families with respect and dignity, and ensures confidentiality of patient records.
• Serves as coverage for incoming calls both from internal sources as well as external sources and routes appropriately.
• Determines nature of call and routes to the appropriate person or ascertains a clear and concise accounting of the nature of the call and documents same in patient file notes.
• Reviews account with patient and if problem resolution is evident, responds accurately and appropriately or research account.

Qualifications

• Education: High School diploma or GED
• Experience: Two + years’ experience directly related to health care claims processing.
• Familiarity with healthcare medical terminology and coding.
• Basic knowledge in the reimbursement guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability.
• Good communication and interpersonal skills.
• Basic knowledge of PC and Microsoft Office Suite use and application and use of internet.
• Knowledge of patient accounting systems.
• Understands and complies with HIPAA and Protected Health Information rules and regulations.