Patient Account Representative to Outpatient

Position Location: Hospital for Special Care – First Shift, 40 scheduled weekly hours in the Patient Financial Services department.

Qualifications

• Bachelor’s Degree required; commensurate experience will be considered.
• Knowledge of third-party collections and reimbursement.
• Two years of hospital or medical business office experience, or comparable experience with third-party or collection agency.
• Excellent verbal, communication, organizational, interpersonal, and analytical skills.
• Experience with healthcare financial systems and Microsoft Word, Excel & Outlook is required.
• Familiarity with medical terminology preferred.
• Ability to manage multiple projects and priorities while meeting deadlines preferred.

Responsibilities

• Responsible for the accurate billing, timely preparation, and claim submission of assigned accounts.
• Performs regular analysis of accounts to determine collectability and implements appropriate collection, adjustment, or write-off procedures to settle accounts.
• Collaborates with outpatient clinical departments to resolve account issues.
• Reports inconsistencies and trends to management.
• Accepts incoming customer service calls from patients, patients' families, attorneys, and other professionals.
• Demonstrates a thorough understanding of third-party coverage and reimbursement for accurate billing and payment.
• Maintains working knowledge of all hospital contracts and their relevant procedures and guidelines.
• Reviews potential risk applications with Team Lead and/or Manager of Patient Accounts & Reimbursement.
• Keeps Team Lead apprised of unusual activity on a daily basis.
• Communicates concerns relating to patient registrations via established department methods (e.g., shared file, email).
• Reports to Manager of Patient Accounts & Reimbursement on any outstanding unworked account concerns after 3 weeks.
• Responsible for daily claim edit review and submission; maintains ability to cover for the Claims Analyst if necessary, including mailing paper claims and submitting secondary claims (manual and electronic).
• Responsible for timely follow-up on assigned accounts and initiation of appropriate collection procedures as defined by policy.
• Demonstrates a thorough understanding of hospital accounts receivable; uses A/R reports and worklists to prioritize balances over 90 days.
• Concisely documents all efforts in the hospital accounts receivable system.
• Utilizes hospital contracts and reimbursement policies to ensure appropriate adjudication of accounts.
• Reviews account activity through payment reports, collectability reports, or similar to identify contractual or payment variances; analyzes and resolves variances.
• Maintains appropriate working knowledge of the accounts receivable system to ensure accuracy and timeliness of billing.
• Notifies management of any system functionality variations affecting workflow.
• Reviews accounts quarterly to assess collectability and recommends reserve adjustments if appropriate.
• Analyzes and resolves credit balances on a continual basis.
• Follows up on adjudicated denials and coordinates appeals with clinical department leadership; documents all efforts in the hospital AR system.
• Collaborates with the OP Authorization and Charge Capture Specialist to ensure timely submission of appeals.
• Collaborates with other Patient Account Representatives daily and supports colleagues as needed.
• Participates in case concerns with clinical staff when requested.
• Compiles documentation for year-end audits, payer audits, and internal audits as requested.
• Assists management with targeted projects as needed.

Physical Demands

• Requires walking, standing, and sitting with the ability to lift, carry, push, or pull up to 20 pounds frequently.
• Frequently looks at a computer and uses a telephone for extended periods.
• Requires frequent bending, squatting, balancing, reaching above shoulder height, and twisting.
• Continuous use of touch, sight, and hearing; frequent gross grasp and fine manipulation.
• Frequently changes position and moves between hospital areas; occasionally stands for extended periods.
• Frequently works in crowded, noisy environments.

Cognitive Demands

• Requires high levels of independent judgment, problem-solving, written and verbal communication, reading comprehension, and computation skills.
• Ability to adjust schedule to adapt to changing priorities.
• Initiates work independently, accesses resources, and handles multiple responsibilities simultaneously.

Work Demands

• Ability to work under conditions with moderate noise and frequent interruptions.
• Adjusts work hours and schedule to changing department priorities.
• Works both independently and as part of a team.
• Occasional overtime required as needed.