PATIENT ACCOUNT REPRESENTATIVE

Position Summary:

This position works under the general supervision of the Business Office Manager and is responsible for thorough and timely patient account follow up with insurance to ensure accurate accounts receivable reporting. To ensure payments by primary, secondary and tertiary payers and/or self-pay patients are accurate. The Patient Account Representative will be responsible for daily generation of patient statements, answering patient calls and correspondence while providing timely, accurate, professional responses and resolution.. Patient Accounts Representative timely preparation and submission of claims to third party carriers as well as collecting, posting and managing account payments. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities

• Responsible for the accurate and timely preparation and submission of claims to third party payers, intermediaries, and responsible parties according to established hospital policy and procedures.

• Responsibilities include maintenance and control of unbilled claims, including assigned section of patients’ receivables.

• Assists in the balance of the workload among all billers in accordance with established workflow or job specialization, assures timely accomplishment of the assigned workload, and assures that they have enough work to keep busy.

• Keeps in touch with the status and progress of work and makes day-to-day adjustments in accordance with established priorities, obtaining assistance from the supervisor on problems that may arise, such as backlogs, which cannot be disposed of promptly.

• Estimates and reports on expected time of completion of work and maintains records of work accomplishments and time expended and prepares production reports as requested.

• Billing the appropriate agency for services provided utilizing the automated third-party billing procedures.

• Reviews clinical management of patient condition to ensure proper levels of care are notes.

• Searches and retrieves individual patient health records to gather and compile information for billing.

• Responds to inquiries and requests for information from various sources and follows up to ensure a timely response from others.

• Provides data to the Business Office Manager for inclusion in reports and use in performance appraisals.

• Assist in developing statistical reports and control methods in determining receivables and collections. Responsible for accurate processing of secondary and tertiary billing after porting payment on initial claims.

• Responsible for posting of all contractual/adjustments related with payments, maintains files for posting, verifying accuracy of payment, reviews and examines bill types of patient care to third party payers and reviews all remittance advices from third party payer.

• Reconciles daily to ensure third party payer remits are processed accurately, audit all documents received for completeness and accuracy and determine if payments are full or partial.

• Perform and apply standard adjustments.

• Perform follow-up procedures including contacting third party payers regarding amounts due in a timely manner in accordance with hospital Business Office policy and procedures.

• Generate contractual adjustment documentation when appropriate.

• Research and appeal denied claims. • Answer all patient or insurance telephone inquiries pertaining to assigned accounts.

• Run collection reports that serve as a worklist of accounts to contact and the payer for claim status and appropriate action. Use appropriate tools (e.g., websites, phone) according to the applicable policy and procedure to work accounts.

• Call insurance companies regarding any discrepancy in payments if necessary.

• Prepare, review, and transmit claims using billing software, including electron and paper claims processing.

• Identify and bill secondary or tertiary payers.

• Answer patient calls related to questions about the process of their account. Contract patient who has a balance they are personally for to try to obtain payment or to make a formal payment arrangement per Business Office policies and procedures.

• Assist the Cash Posting and Reconciliation Clerk as directed by the RCM with the posting of insurance and patient payment to patient accounts.

• Identify accounts that are denied and not appealable per the Business Office policy and procedure on denials or have been appealed and the denial was upheld and not eligible for a second level appeal or higher. Process an adjustment of the account per the denials policy and procedure.

• Report any discrepancies to the Business Office Manager, providing all supporting documents and recommending resolution.

• Perform other duties as assigned.

Minimum Qualifications: 

• High School diploma or General Equivalency Diploma.

• Certificate in Medical Billing or Professional Coding OR two (2) years of experience in a clinical or hospital setting billing insurance, performing insurance follow-up, posting insurance payments or performing customer service function is required.

• Must be able to successfully pass the Employee Health Program and background investigation.