Patient Account Representative

Job Description

Unit Specific Duties:

Billing


* Ensures claims are billed timely and accurately using the Hospital Claims Scrubber Tool and billing system.

Resolves claim edits.


* Collaborates with departments to resolve applicable claim errors.


* Reports all unbilled claim information and issues that may delay billing to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Customer Service


* Receives and processes correspondence and phone or online inquiries from patients, payers or any other third party in a timely and professional manner.


* Resolves patient billing inquiries and processes patient payments over the phone or in person.

Follow Up


* Follows up on unpaid and denied claims for account resolution.


* Resolves accounts by contacting managed care entities, other third party payer organizations or patients to facilitate timely payments.


* Performs research and makes determination of appropriate actions for payment resolution.

Writes and submits appeals for denied claims.


* Keeps informed of managed care and contractual arrangements to resolve accounts by managed care payers. 


* Assigns root causes to denials based on research.

Payment Posting


* Posts daily cash and adjustments for Hospital and Professional billing.


* Resolves undistributed payments and performs cash reconciliation.


* Reports all payment issues to Management to ensure there is no adverse effect on Hospital Cash Collections or Accounts Receivable. 

Self Pay Credit Balances


* Resolves credit balances that are due to patients.


* Audits and reconciles accounts to confirm credit balance and submits refunds in a timely manner.

Qualifications


* High School Diploma or equivalent.


* Two (2) years related work experience in a Hospital, Physician, or other healthcare setting.


* Strong verbal and written communication skills.


* Works in a collaborative and team manner.


* Efficient organizational skills and effective reasoning, problem solving and critical thinking skills.


* Excellent typing skills.


* Ability to multi-task and demonstrate effective time management.


* Preferred knowledge and use of Microsoft Products: Outlook, Word & Excel.


* Strong attention to detail.


* Ability to process a high volume of work.

Unit Specific Qualifications

Billing


* Knowledge of medical terminology and billing.


* Prior experience with facility billing or a similar role.


* Understands Medicare, Medi-Cal, HMO, PPO and 3rd party rules and regulations.

Customer Service


* Prior experience in a customer service setting.


* Preferred knowledge of health insurance coverages.

Follow Up


* Experience with claim processing and denial follow up and resolution.


* Knowledge of insurance appeal writing.


* Basic knowledge of contracting.


* Understands Medicare, Medi-Cal, HMO, PPO and 3r...