Patient Acct Rep Level III (4612)

Responsible for providing coverage for all Level I and Level II functions in the PFS unit to ensure a consistent staffing complement. This position will also ensure the accurate and timely processing of patient accounts related to billing, collections and reimbursement service for Regional One Health in accordance with PFS standards, policies and procedures assigned to Level II Employees, as well as cash posting, mail handling, scanning, sorting, document assembly, coping, faxing and data entry assigned to the Level I employees.

Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission. Gathers all information necessary to process patient claims. Ensures that daily productivity standards, billing and re-billing files are met to obtain the required completion rate. Conducts training for new hires and provides monthly refresher courses for existing hires.

Essential Function

Performs billing, collections and reimbursement services.

• Ensures that all required financial/demographic information is secured.
• Provides monitoring, follow-up, and research of all assigned patient accounts as required to maintain accurate records pertaining to patient and/or account information.
• Provides courteous and professional customer service at all times.

Ensures that PFS standard and requirement of 100% is met and that all payments are retrieved and posted on the date received.

• Gathers all information necessary to process claim payments and ensures that all clinical data codes associated with claim payment are not changed prior to claim payment.
• Researches submitted cash payments by verifying patient account numbers and appropriate facility.
• Enters all cash receipts and credit card payments to correct accounts and reconciles to batch.
• Monitors and performs cash reconciliation to identify cash posting errors.
• Reconciles cash payments to daily bank lockbox and EFT deposits.

Reviews erroneous claims and researches Commercial guidelines to ensure corrections, adjustments, and proper modifications to claims in accordance with documented billing procedures.

• Responds to patient and insurance company complaints, correspondence, inquiries and requests for information by analyzing charges and bill and contracted arrangements, determining billing errors
• Contacts clinical departments and HIM to obtain information to determine claim integrity and works with department to resolve claims.
• Provides continuous updates and information to PFS management regarding ongoing errors, payer related issues, registration issues and other controllable related activities affecting reimbursement and payment methodology.

Essential Function

Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission.

• Ensures successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000.
• Performs the necessary research in order to determine proper governmental requirements prior to claims submission.
• Collects balance owed from third party payers in accordance with state and federal laws governing collection practices.
• Maintains an active working knowledge of all billing and reimbursement requirements by Payer.
• Continuously receives updates and information regarding challenges and newly revised billing and reimbursement practices to ensure compliance.

Ensures daily productivity standards are met and daily billing and re-bill files are cleared in accordance with documented procedure

• Biller –120 accounts per day
• Collector – 45 accounts per day
• Validator –80 accounts per day
• Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt during workdays
• Ensures daily EOBs, reports and appeal files are cleared within 48 hours of receipt during workdays
• Ensures business service requests are worked and documented within 24 hours of receipt during workdays.
• Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with PFS procedure
• Works all discount applicable generated reports, providing proper documentation and making necessary corrections within 48 hours of receipt during workdays
• Ensures claims are submitted timely and no filing deadline denials are received

Ensures quality standards are met and proper documentation regarding patient accounting records

• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround
• Reviews all payments received to verify accuracy by evaluating the claim, account level charge information, contact and payment terms in accordance with Reimbursement Verification Procedure
• Ensures collection efforts are thorough and ethical to accomplish overall departmental objectives related to outstanding balances

Works collaboratively and cohesively with the team to assist in keeping workload evenly distributed

• Works with PFS Managers to assess the educational needs of employees and provides the necessary training and education on transactional processes
• Ensures consistent, open and honest communication with PFS Director and/or Managers regarding findings, recommendations and other financial opportunities.

Performs support services for departmental associates such as scanning or faxing documents, copying, printing forms, data entry and providing backup to reception area as requested

• Ensures quality standards are met in clerical services performed in accordance with PFS compliance guidelines

Documents and forwards incoming mail and resolve any mail related issues or problems

• Performs mail retrieval, sorting, distribution and inter-facility delivery duties for all PFS associates

Prepares training material for new hires specific to their job functions as they onboard in Patient Financial Services, which consists of:

• Identifies and assesses training needs within department
• Meet with managers and Team leads to ascertain training needs.