Qualifications

• High School Diploma or GED (Required)

Work Experience

• 2 - 3 years in a structured business environment (Required)
• 2 - 3 years in a hospital, physician office, or insurance environment (Preferred)

Licenses and Certifications

Required Certifications/Licensures:

• CPAR certification or must be obtained within two years of employment

Essential Functions

ATTENTION TO BILLING DETAIL - PATIENT ACCOUNT REP:

• Prepares billing and follows up on claims in a timely manner.
• Performs accurate and timely billing and account reviews ensuring that accurate information has been reviewed before sending to applicable payors or state agencies.
• Conducts account review ensuring accurate billing information, enters and revises information as needed prior to claim being submitted.
• Prepares adjustment bills, rebills, reprints claims and/or other source documents.
• Processes failed claims in biller work file according to carrier specific requirements.
• Coordinates with concurrent review precert nurse and/or admitting staff on precertification requirements.
• Prepares daily productivity reports.

CUSTOMER SERVICE - PATIENT CLAIM ISSUES:

• Serves as liaison between patient, employer, and carrier in resolving claim issues.
• Communicates with patient, employer, and carrier regarding claim status.
• Processes patient inquiry requests within 24 hours.
• Assists with Customer Service coverage duties as need arises.

KNOWLEDGE OF BUSINESS OFFICE DEPARTMENT GUIDELINES AND PROGRAMS:

• Demonstrates knowledge of ever-changing payer guidelines and regulations, programs, and machines used.
• Demonstrates mastery of computer programs and office machines used. Strong performance includes mastery of the following skills, tasks, and behaviors.
• Creates and maintains via account notes, all correspondence, whether written or verbal, including discussion with carriers, patients, or guarantors. Scans correspondence into the system.
• Submits Medicare Credit Balance Report quarterly, necessary to ensure that Phoebe Putney Memorial Hospital remains compliant with CMS rules and regulations.
• Attends seminars and education relating to Medicare, Medicaid, and Commercial.
• Attends and participates in hospital and departmental staff meetings.

DOCUMENTATION:

• Documents and submits required information and data in a timely fashion.
• Clearly and accurately documents designated processes, policies, products, service offerings, etc.
• Ensures that documentation is tailored to expected readers/users.
• Uses correct terminology.
• Conforms to required style and format.

Additional Duties

• Adheres to the hospital and departmental attendance and punctuality guidelines.
• Performs all job responsibilities in alignment with the core values, mission, and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
• For non-clinical areas, has attended training and demonstrates usage of age-specific customer service skills.
• Wears protective clothing and equipment as appropriate.