PATIENT ACCOUNT REP-MPG

Responsibilities

• Follows-up on outstanding accounts through contact, and inquiry to third party payors to facilitate prompt resolution, or payment.
• Actively pursues payment from patient, or guarantor on all outstanding account balances, after third party payment, or rejection based upon collection guidelines, on a daily basis.
• Identifies and investigates delinquent accounts for special circumstances affecting payment delays, and recommends the appropriate disposition.
• Reviews bad debt prelist report, on a weekly basis, to ensure that adequate follow-up, or collection efforts have been performed prior to transferring to the bad debt.
• Contacts patients to obtain insurance and COB information, and inform them of financial responsibility. Discusses payment options.
• Prepares appropriate billing documents based upon current payor, and hospital guidelines, for all third party payors.
• Prepares and processes any necessary adjustments, or coding changes on accounts, through the system based upon follow-up, to expedite the collection process, and to ensure the accuracy of the account daily.
• Reviews audit discrepancy report, pulls the account, processes the debit or credit adjustments, rebills the account to the third party payor, and moves monies back to the insurance load.

Qualifications

• Knowledge, Skills, And Abilities:
  • Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
  • Working knowledge of personal computer skills, with proficient use of keyboard and calculator.
  • Ability to prioritize job functions, work independently, and exercise good judgment.
  • Must possess good written and verbal communication skills, good organizational and analytical skills, and strong mathematical aptitude.
• Productivity Standards: Of 75 accounts a day, minimum.
• Quality Standards: Of 95% A/R aging 90 days less than 30% of total A/R.
• Average Account Aging: Accounts on WQ's can not be aged more than 30 days.
• Mailing and Correspondence: Mail and correspondence must be worked within 5 working days.
• Medical Records Requests: Follow-up must be worked within 7 working days from first request.
• Prior Authorization Denials: Account rejections in Quadax must be turned around within 2 days of receipt.
• Denial Write-Offs: Denial Write-Off rate needs to be managed.
• Bad Debt Accounts: Bad debt accounts to be worked weekly and completed by month end.
• Resolve Patient Complaints: Resolve and complete patient complaints daily.

Education

• All post high school education must have been obtained from a recognized College or University.
• Additional education or experience may be substituted requirements on a year for year basis should the substitution not conflict with State or Board certification/license requirements.
• High School Diploma/GED Equivalent Required.
• Associate's Degree in Business Administration Preferred.

Experience

• Six (6) years of responsible work experience in a Business Office.
• Knowledge of UB-04 and 1500 billing Preferred.