Description

BUSINESS OFFICE - PATIENT ACCOUNT REPRESENTATIVE II

JOB TITLE: Patient Account Representative II

GENERAL STATEMENT OF DUTIES:

To keep current on a daily basis, the posting of charges and payments using the proper CPT/ICD 10 codes. To maintain the daily and weekly operations of computer-generated insurance claims and billing statements.

SUPERVISION RECEIVED: Reports to the Business Office Manager

SUPERVISION EXERCISED: None

TYPICAL PHYSICAL DEMANDS:

Requires sitting for long periods of time working in office environment. Requires visual ability that is correctable to 20/30

Some bending, lifting and stretching required. Working under stress and use of telephone required. Manual dexterity required for use of calculator and computer. Good oral and written communication skills required.

TYPICAL WORKING CONDITIONS: Normal office environment.

EXAMPLES OF DUTIES: (This list may not include all of the duties assigned.)

1. Reviews charges for Clinic, ARISE, Physical Therapy and ancillary service for preparation and processing of charge posting in NextGen.
2. Reviews CPT, ICD-10, modifiers to prepare encounters for billing.
3. Runs claim edits and make the necessary claim correction to create clean claim following payer guidelines.
4. Applies patient payments such as copays and visit charges during charge posting.
5. Receives, reviews and posts batches of payments, electronically or manually, ensuring accuracy of payments and contractual allowances.
6. Review of Explanations of Benefits for accuracy of reimbursement per contract. Report any discrepancy in reimbursement to the manager and/or Team Lead.
7. Collects insurance information from patients and verifies eligibility and benefits by contacting insurance carriers and other third-party payers.

EXAMPLES OF DUTIES (Continued)

1. Bills patient accounts and assures accuracy by reviewing and verifying patient charges, coordinating benefit levels, type of coverage, and/or approval for coverage.
2. Counsel patients regarding account balances and answers patient questions
3. Contacts assigned list of patients by telephone and correspondence regarding past due accounts. Arrange payment plans, ensure all insurance payments are received and refer accounts to collections agency following collection’s protocol.
4. Investigates and resolves insurance claim rejections within the appropriate time.
5. Collects insurance accounts by contacting insurance carriers and other third-party payers to verify receipt of billing and other information needed to process claims, secure approximate date of payment, negotiate with claims personnel for prompt payment and resolve discrepancies in billings within appropriate time frame.
6. Provides information regarding work progress, actions, and issues in a timely and effective manner.
7.  Reconciles accounts, adjusts balances to reflect denials, adjustments, cost-share, payments, and other modifications to balances.
8. Prepares patient and third-party refund requests for approval.
9. Runs Account Receivable reports to search for denied and delayed claims.
10. Troubleshoots problems, communicates problems and recommendations to supervisor and/or Team Lead
11. Other Duties as Assigned: The assignment of duties to employees is not limited to the content of this job description. Other tasks and assignments may be related to the work usually assigned to the employee, but in some circumstances may be completely unrelated.

PERFORMANCE REQUIREMENTS:

Knowledge, skills and abilities:

• Knowledge of ICD 10 and CPT coding.
• Knowledge of medical billing policies and requirements.
• Skill in using computer and calculator. Clear written and oral communication.
• Ability to examine documents for accuracy and completeness.
• Ability to work effectively with patients and co-workers.

COMPLIANCE:

1. Follows compliance requirements mandated by HIPAA, Medicare and all other ARA contracted carriers. This should include a working knowledge of how others are accountable within the practice as well.
2. Knowledge of financial and coding practices necessary to insure the accurate submission of charges for services rendered in accordance with all federal, state and local regulations.
3. Knowledge of all applicable regulations regarding collection activities.
4. Follow guidelines for maintaining patient confidentiality.
5. Demonstrates a strong commitment to honest and responsible corporate conduct.
6. Identifies reports and/or prevents any fraudulent or unethical behavior.
7. Initiates notification to management if inappropriate behavior is observed within the organization.

HIPAA-Minimum Necessary Access to PHI

The responsibilities associated with this position allow access to the computer role of Billing only. We are committed to enforcing minimum necessary access to our patients PHI by limiting the uses and disclosures of this information within our practice. In order for this employee to carry out his/her job (carry out TPO) in a manner that best serves our patients, the employee needs access the afore mentioned computer role. Role descriptions are explicitly defined in our HIPAA manual. Access to computer information is password protected. Upon termination of an employee, his/her password will be deleted from the system.

Qualifications