Job Title – Position Description: Patient Accounts Representative

Reports to: Patient Accounts Supervisor

MISSION

Reviews claims to make sure that payer specific billing requirements are met by utilizing payer websites, payer payment andmedical policies for insurance follow-up to improve cash collection efforts. Review denials for trends and help identify rootcauses. Work with coding and leadership to draft appeals using all available resources and follow the denial through all appeal levels as needed. The responsibilities also include and are not limited to following-up on claim processing toreconcile patient accounts using all available resources such as payer portals, EOB’s and applying adjustments as needed. Accurately update patient accounts as necessary, and being a reliable partner within our team to provide an exceptionalbilling and collections service that enhances the patient experience

OUTCOMES

• Able to effectively navigate through complex information in regard to insurance/payer medical policies, individual plan type details, referrals, authorizations, and account follow-up in a timely manner.
• Responds effectively to the reactions and positions of payers to recommend adjustments and bring timely resolution to accounts.
• Coordinate activity with collections team to ensure timely, accurate rebill of accounts, while facilitating quality improvement through reporting opportunities for increased revenue and decreased denials.
• Maintains up to date knowledge regarding government and commercial payors status and their insurance products, associated Explanation of Benefits (EOB), and other information related to accounts receivable follow-up.
• Ensures maximum entitled reimbursement and review appropriate allowances and adjustments by clearing balances on accounts and pursuing billing of secondary insurance or patients.

COMPETENCIES

Job Related Competencies:

1. Manages Complexity: Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
2. Persuades: Using compelling arguments to gain support and commitment of others.
3. Plans and Aligns: Planning and prioritizing work to meet commitment aligned with organizational goals.
4. Resourcefulness: Securing and deploying resources effectively and efficiently.
5. Drive Results: Consistently achieving results, even under tough circumstances.

 Cultural Competencies:

Advanced Values:

1. People
   • Collaborates: Building partnerships and working collaboratively with others to meet shared objectives
   • Heart
     • Patient Focus: Building strong patient relationships and delivering patient centric solutions
   • Service
     • Instills Trust: Gaining the confidence and trust of others through honesty, integrity, and authenticity
   • Excellence
     • Cultivates Innovation: Creating new and better ways for the organization to be successful

QUALIFICATIONS

Basic Qualifications:

Education:

• High School Diploma or GED

Previous, Job Relevant Work Experience:

• 4  years of experience in healthcare-related field or setting
• Working knowledge of Medicare, Medicaid, and other contract payers (HMO, PPO)

Preferred Qualifications:

Previous, Job Relevant Work Experience:

• 5  years of experience in healthcare related setting.
• Previous experience in Clinic, ASC or Hospital setting.
• Experience in medical billing, accounts receivable, or collections.
  • Knowledge of medical terminology, insurance billing procedures, and healthcare reimbursement mechanisms.
    • Working knowledge of E-clinical Works
    • Working knowledge of payor portals and Availity.
    • Working knowledge of Clearinghouse system.
• Strong negotiation and problem-solving skills to resolve billing discrepancies.
• Ability to work independently, prioritize tasks, and meet collection targets.

Credentials/Licensures:

• Certified Patient Account Representative (CPAR)