Patient Relations Representative IV (10775)

: Primary purpose of this position is to validate patient account information via the patient encounter form and various clinical records to ensure correct billing for services rendered and post to A/R ledger.

: - Responsible for posting daily charges from eSuperbill or encounter forms by 5:00pm.

• Responsible for verifying completeness of all information such as charge codes, diagnosis and modifiers, provided by clinical staff at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Determines correct method of resolving discrepancies by tasking and following up with appropriate staff to obtain complete information.
• Review patient demographic information at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration.
• Review insurance details, family household income, current charges and/or outstanding balances and verify dates of services.
• Review all claims for accuracy prior to submission.
• Schedule follow-up appointments
• Ensure all encounter forms are received by the Billing Office for charge entry.
• Demonstrate an understanding for patient confidentiality to protect the patient and the organization.
• Follow policies and procedures that contribute to the efficiency of the billing office.
• Keeps supervisor informed of matters regarding charge entry.
• Respond to inquiries from the clinical staff, social workers, and clerical staff regarding billing and coding information of the patient. Provide income verification and insurance documentation to clinical staff, as requested, to support referrals and/or orders.
• Collect and post payments from, both current and outstanding, patient debt to individual accounts. Payment plans are setup for accounts not paid in full. Other methods may be through the normal billing process or by utilizing the Countys NC Debt Set-Off program currently in place.
• Notify our in-house Debt Set-Off coordinator of 60-day delinquent accounts for submission to the IRS.
• Keep informed of updated fee scales as published by the Health Department and other agencies, along with private provider updates for filing of claims. This is important so that the Health Department can achieve the maximum collection.
• Verifies encounters received against the daily schedule and tracks missing encounters as well as encounters returned to the clinic for missing information.
• Balance daily deposits to the cash drawer via the day sheet. A deposit slip is prepared and turned in to the accounting section by the Accounting Tech III.
• Contact insurance companies for unpaid claims and patient verification.
• Ensure all prepayments are applied to charges by 5:00pm.
• Review and update pending insurances for eligibility. If eligibility cannot be determined, services older than 60 days are considered to have no coverage and then transferred to the patients responsibility.
• Responsible for mailing Company Billing invoices monthly by the first of every month
• Turning on television in the lobby by 8:00am and off by 5:00pm
• Provide backup to other Patient Relations Representatives positions within the unit.
• Required to construct letters as the need arises. The Administrative Officer will review all correspondence before documents are released outside of the agency. Correspondence pertains to letters to other agencies, insurance carriers, and health department patients. All documentation should be proofread for spelling, punctuation and grammar.
• Other duties as assigned by supervisor(s) and/or management.
• In the event of a disaster, may be required to assist as needed.
  
  

: Graduation from high school and demonstrated possession of knowledge, skills and abilities gained through at least two years of office assistan /secretarial experience; or an equivalent combination of training and experience.

Knowledge, Skills, And Abilities

Requires a comprehensive understanding of accounts receivable management in a healthcare setting. Strong customer service, organizational and communication skills are essential to this position. Strong working knowledge of CPT, ICD-10, HCPCS, modifiers, coding and documentation guidelines. Also requires general computer skills, typing skills and a working knowledge of Medicaid and Medicare Compliance, OSHA and HIPAA.