Patient Accounts Representative

About the role

Responsible for the insurance billing process between the hospital and insurance companies, federal agencies, and third-party payers. Audits patient accounts to ensure procedure, charges, and coding accuracy. Collects payments from commercial insurance companies, state and federal agencies. Participates in performance improvement and continuous quality improvement (QI) activities.

Responsibilities

• Coordinates the payment process and collects payments from insurance companies, federal and/or state agencies, and/or third-party payers by utilizing the billing system to complete appropriate forms and submit claims to proper agencies/insurance companies.
• Maintains a professional, working relationship with insurance companies, government agencies, and/or third-party payers.
• Works independently to resolve account problems and ensures timely follow-up.
• Resolves overpayments and communicates with the Business Office Director on refunds.
• Assists with the receipt process and adjusts patients’ bills to reflect credits, debits, and balances.
• Understands the pre-certification and referral process as it relates to assigned insurance.
• Documents all correspondence and conversations with insurance companies, governmental agencies, third-party payers, and patients on patient accounts.
• Stays informed of changes in the insurance industry.
• Consults with other hospital departments to obtain and verify billing information.
• Accepts other assignments as needed and demonstrates flexibility, organization, and the ability to function well in stressful situations.
• Communicates clearly and accurately with the Business Office Director and other staff members.
• Performs limited account audits using available information to verify accuracy in charges and coding.
• Maintains a good working relationship within the department and with other departments of the hospital.
• Coordinates with patients and insurance companies to resolve unpaid insurance claims.
• Interacts with patients/families in a professional manner, providing explanations regarding statements and insurance procedures.
• Treats patients/families with respect and ensures confidentiality of protected patient information.
• Utilizes voicemail as necessary to ensure quality customer communication when out of the office.
• Prepares daily deposits and maintains the correct balance in the cash drawer.
• Handles payment transactions, including downloading and balancing electronic remittance advices and providing customer receipts.
• Prepares and posts adjustments, contractuals, and rejections.
• Enters all transactions into the computer system accurately and in a timely manner.
• Utilizes the safe for large bills and large amounts of money from the cash drawer.
• Provides petty cash to various departments of the hospital and collects daily revenues from these departments, providing receipts for all transactions.
• Provides change to patients, visitors, and employees.
• Receipts payments received in the Admitting Department and/or directly from the patient/family.
• Assists customers who present at the business office counter.
• Ensures security measures, including placing the cash drawer in the safe upon closing.
• Manages and operates all equipment safely and correctly.
• Enters accurate documentation on patient accounts when applicable.

Professional Requirements

• Adheres to dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Reports to work on time and as scheduled; completes work within the designated time frame.
• Wears identification while on duty and uses the computerized time system correctly.
• Completes hospital in-services as required.
• Utilizes access to internet web-based insurance resources for education, eligibility, follow-up, and billing as applicable.
• Maintains and ensures patient confidentiality at all times.
• Performs department in-services.
• Works at maintaining a good rapport and a cooperative working relationship with physicians, departments, and staff.
• Represents the organization in a positive and professional manner.
• Attends committee, CQI, and management meetings, as appropriate.
• Ensures compliance with policies and procedures regarding department operations, fire, safety, and infection control.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, vision, and core values of the hospital.
• Demonstrates knowledge and/or location of the Safety/Emergency Preparedness Manual, location of disaster packets, personal protective equipment, and responsibilities during all Codes.
• Adheres to William Newton Hospital’s policies and demonstrates familiarity with the employee handbook.

Qualifications

• High school graduate or equivalent.
• Thorough understanding of different insurance plans, government agencies, Medicare, and Medicaid as relates to assigned insurance responsibilities preferred.
• Previous billing experience preferred.

Schedule

7:30 AM – 4:00 PM