Job Title : Patient Account Representative 1 - Hospital

Job Summary : The Patient Accounts Representative 1 monitors the patient accounts process. This entry-level Patient Accounts Representative 1 works with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and professional charges. The Patient Accounts Representative 1 is responsible for the billing and collection functions for multiple providers. The incumbent must review accounts on the practice management system and distinguish between balances and/or credits belonging to managed care vs the patient. The Patient Accounts Rep 1 is responsible for collections on delinquent insurance and patient balances and for working credit balance reports, posting payments and adjustments, and filing claims and appeals denials with managed care companies.

• Required Experience : 1 year experience or related certification program in areas such as billing, medical office, coding and accounting. Bachelor's Degree or Associate's Degree, trade school, or certification substitutes 1 yr exp.
• Required Education : High School or equivalent
• Special Skills : Must possess knowledge of ICD-9/10, CPT and HCPCS coding. Must have accurate data entry skills. Must be able to answer multiple phone lines with incoming and outgoing calls. Must understand the explanation of benefits of various managed care companies. Must be able to demonstrate teamwork and willingness to work in cooperation and support of others as well as comply with FMOLHS policies and procedures.

1. Customer Service
   1. Promptly answers inquiries from patients, co-workers, and employees regarding patient accounts in a kind and courteous manner.
   2. Assists in providing quality training and orientation for assigned employees.
2. Payer Relations
   1. Advises patient or guarantor of third party payer benefits and estimated private payer amount and collects partial payments prior to admission in a manner that promotes the provision of high quality health care services by the department.
   2. Reviews patient papers and documentation for reported information accuracy, and researches errors on patient accounts, billing and insurance problems, and lost payments in order to ensure accurate record maintenance and prudent departmental operation.
   3. Makes written and verbal inquiries to third party payers, reconciles patient accounts, and makes payment arrangements in an effort to ensure that patients are free from financial burden and that patient interests are appropriately represented.
   4. Oversees collection letter mail-outs for delinquent unpaid patient accounts in a prudent and efficient manner.
   5. Sends itemized patient account statements per attorney request or in response to subpoena in a professional and diligent manner.
   6. Reviews claims to make sure that payer specific billing requirements are met.
   7. Follows up on claims, determines and applies appropriate adjustments.
   8. Updates accounts.
3. Receivables
   1. Works with external agencies and companies to provide patients with prompt reimbursement for hospital services. Interprets, explains, and counsels patient and family regarding hospital charges, services, and payment policies in a manner sensitive to the needs and financial situation of the patient.
4. Quality
   1. Maintain a quality accuracy average of 95%
   2. Maintain a production set by management for specialty focus.
   3. Thoroughly completes assigned tasks with in the requested timeline.
5. Other Duties As Assigned
   1. Performs other duties as assigned or requested.

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