Patient Account Representative - Billing

Responsibilities

• Extends payment arrangement offers to guarantors in accordance with department policies and procedures.
• SUBMIT CLAIMS: Submits coded, complete, timely, and clean claims to assigned carrier(s), either electronically or on paper, on a daily basis, with accuracy and in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier.
• WORKS CLAIM EDITS: Reviews and works claim edits, and resolves claim quality issues and follows up on missing information.
• RECONCILES CLAIM SUBMISSION INDEX: Reconciles claim submission index in CPSI (EBOS) to ensure that electronic claims submitted are cleared through the clearinghouse and accepted by the carrier. Follows up on outstanding claim files.
• TAKES ACTION ON CORRESPONDENCE: Takes appropriate and timely action on all correspondence related to assigned carrier(s) in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier.
• COLLECTS BALANCES: Reviews posted remittance advices from assigned insurance carrier(s) within the timeframe established by department policies and procedures, appropriately following up on and resolving any rejections or other non-payments to ensure accurate posting of balances for reimbursement, deductible, co-pay, co-insurance, contractual adjustments, non-covered charges, rejected claims, and any balance-billing to the patient or guarantor as appropriate.
• COMMUNICATES WITH INTERNAL AND EXTERNAL PARTIES: Communicates appropriately with others within the organization to keep them informed of any non-payment or denial applicable to their area of service or responsibility.
• FOLLOW UP ON OUTSTANDING CLAIMS: Follows up on outstanding insurance claims on a daily basis using the Billed but Unpaid report, as well as any priority listing of unpaid claims as assigned by the Billing & Collections Manager and or Director of Revenue Cycle.
• RESPOND TO INQUIRIES: Responds to internal and external account inquiries in a timely manner and with the utmost professionalism and courtesy. This includes actively participating in the main line phone queue throughout the day.
• MANAGES DOCUMENTATION: Timely management of documentation in the office in accordance with department policies and procedures (ie. filing, scanning, etc.), and in compliance with privacy requirements of HIPAA, to promote an efficient work flow, ready access to necessary documents by all of the appropriate parties, and the protection of private health information.
• PREPARES RECOUPMENT REQUESTS: Reviews credit balance accounts at least weekly to identify potential overpayments and submit timely requests for recoupment or refund, in accordance with the requirements of the assigned carrier(s) and department policies and procedures.
• WORKS COLLABORATIVELY ON APPEALS: Works collaboratively with others in the organization to appeal non-payments or denials of claims for services, as appropriate, and in accordance with the requirements of the assigned carrier(s).
• ENTERS NOTES: Enters appropriate, succinct, and professional notes in patient accounts in a timely manner for ALL communications with, or regarding, patients, guarantors, or insurance carriers.
• MONITORS BILLS AND EDIT POLICIES: Keeps self informed of billing policies and requirements of assigned insurance carrier(s) by regularly monitoring list-servs, carrier websites, maintaining open lines of communication with provider representatives, researching problem claims, and other means of staying informed that the assigned carrier(s) makes available.

Qualifications

• High School Diploma or equivalent.
• MEDICAL TERMINOLOGY COURSE DESIRED.
• DESIRED HEALTH CARE INSURANCE BILLING EXPERIENCE, OR EXPERIENCE IN A HOSPITAL ADMITTING, REGISTRATION, BUSINESS OFFICE, OR CODING FUNCTION.