Senior Representative - Patient Account Collector
About the role
This position performs collecting, reconciliation, credit balance resolution, research, correspondence and independent problem solving. Reconciles complex, multi-payment accounts. Submits appeal letters on underpaid claims as directed. Interprets payer contracts to determine if payment and PCON adjustment is accurate. Reviews EOB's for denials, along with posting corrected adjustments in order to balance accounts. Identifies needs for process improvements and creating/enhancing processes in the PFS department. Promotes positive teamwork within department and among employees. Works with all hospital departments for proper coding and billing procedures. Follows all departmental, hospital, and regulatory policies and procedures, including HIPAA requirements. Utilizes top customer service skills with all customers: patients, government agencies, commercial insurances, other hospital departments, physicians' offices and attorneys' offices.
Responsibilities
- Reconciles accounts on a daily basis to determine underpayment, overpayment or contractual adjustment correction. Utilizes technical ability and understanding of applicable insurance contracts and regulations.
- Maintains current knowledge of regulatory billing requirements for specified payors. Attends in-services/continued education
- Interprets data processing reports and applies the information as needed for daily departmental productivity.
- Trains other staff members on reconciliation techniques and other aspects of the position.
Qualifications
- High School Diploma or GED - Required
- 18 months patient accounts experience - Required
- 18 months billing, collection or Medicare/Commercial billings - Required
Skills
- Experience working with Aetna commercial or other commercial payers
Education
Other post high school education, to include, but not limited to accounting courses or medical business office certificate program - Preferred