Accounts Representative

Primary Purpose: To ensure that all billing and collection is done in a timely manner and in accordance with the provider insurance contract.                        

Formal Policy-Setting Responsibilities: Formally responsible for making recommendations regarding policies associated with the job’s purpose and essential responsibilities.                  

Routine Decision Making: Accurate billing setup, knowledge of electronic billing edits. Accurate claim form set up. UB billing guidelines. Understanding of ICD-10 and CPT codes guidelines. Billing and reimbursement guidelines for services billed per payer.                                              

Formal Supervisory Responsibility: Formally responsible for providing input into policies associated with the job’s purpose and essential responsibilities.                                          

Unusual Working Conditions: None.                                       

Essential Responsibilities and Tasks

Follow-up on all commercial insurance, MC MCD (80% of time)                             

• All accounts are reviewed for accuracy of billing guidelines to include CPT, ICD 10, and modifier usage.     
• Understanding of priority of accounts by dollar and age meeting productivity and quality standards and to work all accounts within 30 days of denial or billed date. 
• Denials are reviewed and reported as trending issues to the Billing Coordinator.                 
• Unapplied credits are worked monthly.                  
• Contact IS for any computer issues immediately. 

Customer Service: Is able to handle all aspects of accounts resolution in order to resolve any issue with patient/account. (i.e., insurance issues, rebilling claims, credit balances) (15% of time) 

• Provides Excellent Customer service to all individuals representing the Cass Regional Medical Center Values. 
• Acts as back up to Cashier or PBX operator as needed.
• Acts as a financial advocate for the patient in understanding and reconciling statements and or daily charges.  Accepts payments and posts accurately.  Documents all conversations completely and timely. Accepts and processes Financial Assistance and Patient Concerns according to policy  
• Answers phones cheerfully by 3^rd ring, identifying yourself and Cass Regional.  Phone line is always open and all voicemails are answered by the end of the day.   
• Accurate application of Financial Class, transaction codes, payer class etc.

Actively participates in Business Office Operations and all other duties as assigned. (5%)              

• Willingly takes on other duties as assigned.                                                          
• Uses available resources efficiently and effectively. I.E., Manuals, Internet Payer Websites, etc.   
• Participates in process improvement for business office procedures and actively follows all policy and procedures of the department. 
• Actively participates and follows all department policy and procedures

ESSENTIAL PHYSICAL REQUIREMENTS

• Sedentary Work: Lifting 30# maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools.  Jobs are sedentary; if walking and standing are required only occasionally.                                                        

PHYSICAL DEMANDS 

• Lifting:  Raising or lowering an object from one level to another (includes upward pulling).             
• Carrying:  Transporting an object, usually holding it in hands or arms or on the shoulders.               
• Pushing:  Exerting force upon an object so that the object moves away from the force (including slapping, striking, kicking, and treadle actions).                                                      
• Pulling:  Exerting force upon an object so that the object moves toward the force (includes jerking).        
• Climbing:  Ascending or descending ladders, stairs, scaffolding, ramps, poles, ropes, and the like, using the feet and the legs and/or hands and arms.                                       
• Hearing:  Ability to determine audible communication.                                                   
• Stooping:  Bending the body downward and forward by bending the spine at the waist.                   
• Kneeling:  Bending the legs at the knees to come to rest on the knee or knees.                                    
• Crouching:  Bending the body downward and forward by bending the legs and spine.                       
• Reaching:  Extending the hands and arms in any direction.                                                             
• Handling:  Seizing, holding, grasping, turning, or otherwise working with the hand or hands (fingering not involved).                                                            
• Fingering:  Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arms as in handling).                                                                                                 
• Repetitive Motions:  Substantial movements (motions) of the wrist, hands, and/or fingers.
• Speaking: Expressing or exchanging ideas by means of the spoken word.  Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.                                                
• Seeing:  Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects.                                                                             
• Accommodations - adjustment of the lens of the eye to bring an object into sharp focus.                

WORKING CONDITIONS

• Inside:  Worker spends approximately 75% or more of time inside.                                                            

Education and Certification required for the position: High school education. Previous experience utilizing ICD-10 and CPT coding is preferred. CRCR or comparable certification preferred.      

Required Knowledge: Knowledge of state and federal rules and regulations, to include Critical Access Hospital; billing standards; CPT and ICD-10 coding guidelines; medical computer software programs; and insurance policies and procedures, Washington Publishing Company denial and remittance codes. CCI and NCCI edits, understanding of accurate use of modifiers, Excel.                               

Required Skills and Ability: Application and maintenance computer skills; verbal and written communication skills, to include writing appeals. Ability to prioritize and work independently, problem solving skills.