PATIENT ACCOUNTS REPRESENTATIVE

Job Title: Patient Accounts Representative 

Department: Billing 

Reports To: Patient Accounts Manager 

FLSA Status: Non-Exempt 

Summary: 

Responsible for reviewing insurance claims for accuracy and timely filing on behalf of the organization, to procure the monetary collection process of insurances, vendors and third-party payments along with timely patient portion billings to meet the organization’s policy and procedure requirements for receipt and collection processes.   

Essential Duties and Responsibilities: 

Achieve Results 

• Ensure timely and accurate billing and collection of medical claims.  Ensure that the billing and collection processes meet or exceed the organization’s financial and operational goals.  

• Ensure timely and accurate claim follow up on denied and/or appealed claims. Assist problem resolution between the organization and its patients, payer sources, as necessary to expedite claims processing and patient balance billing process. 

• Monitor accounts and identify outstanding balances and follow up as necessary, informing Patient Accounts Manager of issues or obstacles delaying speedy claims processing and patient billing. 

Operational Excellence 

• Ensure all billing processes and collection functions are compliant with all internal policies as well as state, local, and federal laws, regulations, regulatory and/or best practices.  

• Ensure all billing and collection efforts contribute to a positive patient experience.   

Relationships  

• Develop and ensure effective, positive relationships within and among the Patient Accounts staff, as well as with other departments within the organization.  

• Develop and ensure positive working relationships with patients, contractors, vendors, third party payers, and other departments this position supports.  

Leadership & Stewardship 

• Uphold and consistently represent the values, mission, and policies of the organization.   

Primary Tasks and Duties 

• Submit claims to the appropriate health plans daily, review all denials for complexity, make corrections, and resubmit claims within 30 days of the denial received date.   

• Complete claim forms, submit bills and claims, perform quality control procedures on all claim forms and detail bills to ensure accurate billing.   

• Contact patients regarding denials that require patient follow up and/or assistance.  

• Responsible for running all billing ageing reports and maintaining documentation supporting follow-up decision processes.   

• Complete insurance refunds in a timely and accurate manner.   

• Participates in meetings and training as required.   

• Other duties as assigned.   

Essential Functions & Key Competencies        

• Demonstrate a strong business acumen as well as substantial knowledge and expertise in medical claims and billing.  Analyze, synthesize and communicate complex data, clinical information, business needs and related issues in an accurate, objective, and straightforward manner.   

• Demonstrate a high level of problem-solving skills.  Demonstrate the ability to make critical medical billing decisions supported by substantial financial analysis and critical data-based decision making.   

• Effectively manage conflict and change.     

• Demonstrate interpersonal savvy and influence skills in all dealings with regulatory agencies, government entities, network providers, and related concerns.  

• Demonstrate and engage in the use and development of technology to provide information and analysis of departmental outcomes and process improvement.   

• Ensure all wide-spread billing issues are communicated to Patient Accounts Manager.  

Qualifications: 

Education   

• High School diploma or equivalent. 

Professional   

• Demonstrated “skilled” business office experience.   

• Demonstrated success in communication, customer service, or working with the public, preferably in a medical care facility.   

• Demonstrated success in managing difficult situations.   

• Demonstrated success in general computer competence, including basic Word and potential to be trained in specific software for patient information, billing, and communication.   

• Epic EMR experience is preferred.   

• Basic medical, dental, and/or vision insurance knowledge is preferred.  

• FQHC billing experience is preferred.  

Language 

• Ability to speak, read, write, and understand English. 

Physical Demands: 

• Ability to interact with computer screens for up to six hours at a time (visual acuity required).   

• Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail, and in person to resolve disputes, solve problems, etc.   

• Capacity to function in a sometimes stressful, multi-tasking environment.   

Work Environment: 

• Fast-paced community health center setting, potential exposure to infectious diseases, and interaction with a diverse patient population. 

Benefits: 

• Medical, Vision, and Dental coverage, 4% 401k Contribution, $50 a month HRA contribution to be used towards qualifying medical expenses, Paid Time Off (PTO) plus paid holidays. 

Equal Opportunity Employer: 

• North Olympic Healthcare Network is an equal opportunity employer (EOE). All applicants will receive equal consideration for employment without regard to age, race, color, national origin or ancestry, ethnicity, family or marital status, sex, genetic information, disability, creed, religion, citizenship, socio-economic status, military or veteran status, or any other characteristic protected under applicable federal, state, or local law. 

Salary : $20 - $24