Job Description
The Patient Account Representative 4 is a liaison to review and resolve complex Patient Accounts issues and may be responsible for the customer service, posting, billing and/or collection process of the Patient Accounts process. It is the responsibility of the incumbent(s) of this position to incorporate the Mission values and philosophy of the organization into the completion of all job duties. Relies on experience and judgment to accomplish responsibilities; Works under minimal supervision; Creativity is expected to perform job and may lead and direct the work of others. REMOTE/TELEWORK
MINIMUM REQUIREMENTS
Education: High School or equivalent
Experience: 8 years experience in Revenue Cycle / Hospital Business Office programs (Customer Service, Billing, Follow-up) or equivalent industry experience.
Related certification program in areas such as billing, medical office, coding and accounting can be substituted for 1 year of experience.
Bachelor's Degree can substitute for 4 years of experience; Associate's Degree can substitute for 2 years of experience.
Skills and Training: Must possess knowledge of ICD-9/10, CPT and HCPCS coding.
Apply critical thinking and problem solving skills as it relates to resolving accounts.
Must understand the explanation of benefits of various managed care companies and regulations.
Must be able to demonstrate teamwork and willingness to work in cooperation and support of others as well as comply with FMOLHS policies, procedures and core values.
Communication, interpersonal and collaboration skills.
Primary Responsibilities:
Execute Business Office Operations and Functions

• Performs billing, collections, payment processing and/or customer service tasks according to documented process, applying critical thinking to determine appropriate outcomes based on the situation.
• Updates account with ownership and accountability of the entire account at that point in time; Notes should be sufficient and complete to describe current situation and next steps.
• Leverages contract knowledge and expertise to drive revenue
• Evaluates root cause and resolves issues on that specific account being worked in timely manner to maximize revenue flow, minimize write-offs and maintain customer satisfaction
• Completes most transactional updates with one interaction; completes majority of work independently including most of the complex scenarios and collaborates with other internal departments and external entities as appropriate
• Identifies patterns, trends in account issues and escalates as appropriate so root cause can be addressed and improved.
• Maintains subject matter expertise on regulations, process and policies by attending training and applying in daily work
• Consistently meets production and quality requirements for area, driving overall department objectives for A/R, Claim Counts and past dues.
• Responds to requests (from customers, co-workers, management) in a timely and professional manner.

Planning and Support

• Assists with planning and participates in internal and external meetings as a representative of department
• Serves as a subject manager expert to other team members.
• Provides training / shadowing support for new team members
• Identifies areas for improvement or fixes to system edits / processes and communicates to appropriate owner to resolve issues
• Collaborates with Payor Relations and Vendors over contract issues; researches Payor issues, coordinate to resolve payment and reimbursement issues
• Creates & updates workflows, using SME knowledge and insight on trends identified to drive process improvements

Other Duties as Assigned

• Leads special projects / updates