Under the supervision of the Assistant Director of Patient Accounts, the Patient Account Representative performs a variety of duties relating to review, analysis, billing, follow up, accounts receivable, adjustments and finalizing of third-party and self-pay accounts receivable.
Coordinates and schedules work responsibilities to ensure timely and accurate billing and follow up to all written, telephone and computer generated account inquiries.
Reviews, corrects and completes all patient and third-party initial billing and corrected claims before submission to third-party payers or patients. Initiates necessary patient demographic, insurance, charge, and coding corrections needed in working with necessary Departments to facilitate changes needed in the system before generating claims to payers.
Ensures that billing time limit filing requirements are met including providing necessary pertinent documentation as proof of timely filing based on various third-party payer requirements.
Makes necessary corrections to various computer software systems such as MEDITECH, proprietary electronic software provided by third-party payers and other vendor electronic software.
Performs electronic transmission of claims to third-party payers and performs necessary batch reconciliation review to ensure claims were received by the third-party payer for processing.
Processes third-party payer and patient payments, adjustments and denial information to patient accounts.
Batches and scans financial documents that need to be kept into the optical imaging system for retrieval and audit purposes as needed.
Generates patient statement mailers for self-pay and balances after insurance.
Negotiates and establishes monthly budget payment plans with patients for those who cannot pay in full upon receipt of first billing statement in accordance with hospital credit & collection policy.
Attend educational seminars and workshops regarding third-party payer, state and federal program requirements.
Receive and respond to all incoming telephone inquiries from third-party payers, patients, attorneys, physician offices and other general public.
Responsible for cross-training to all phases of Patient Account billing, cashiering and follow-up procedures.
Review third-party payer remittance advices to ensure proper posting and payment.
Perform timely third-party follow up of unpaid claims by telephone, electronic web based claim status inquiry, fax and through written inquiries based on Department aged trial balance and various third-party payer requirements.
Initiate third party and patient refund requests including necessary supporting documentation for overpayments received by third-party payers and/or patients.
Prepare written third-party payer appeals when technical payer denials are received that require supporting documentation in order to payer to reconsider denial for payment. Ensure that denials requiring appeal are submitted within their established timely filing limit based on specific payer requirements.
Review and recommend referral and write off of accounts to bad debt when all hospital, state and federal criteria has been met including minimum number of statements, date of first bill, telephone calls, certified letters, etc. for audit proposes.
Knowledgeable of specific third-party payer requirements regarding patient demographic, insurance and referral/authorization requirements obtained during the patient registration/scheduling process to ensure information obtained is complete and accurate to minimize unnecessary payer denials.
Knowledgeable of ICD9, CPT, and Uniform Billing Revenue Coding requirements specific to each payer as it relates to payment and denial of services to initiate corrections needed to MEDITECH B/AR module or by Health Information Services for resubmission of claims for correct adjudication.
Basic knowledge of medical terminology as it pertains to billing and coverage of services. Must be knowledgeable of specific payer coverage limitations based on medical necessity guidelines and patient waiver requirements.
Knowledgeable of hospital and HIPAA patient confidentiality and privacy of patient health information policies and requirements as it pertains to release of patient health information to patients, payers, attorneys and other general public.
Knowledgeable of Free Care and other available financial assistance programs to assist patients in applying and supplying necessary verifications to determine eligibility.
Ensure that pre-payment or necessary financial arrangements have been made prior to or at time of service for uninsured patients having elective services in accordance with hospital=s credit & collection policy.
It is understood that this is a summary of key job functions and does not include every detail of the job that may reasonably be required.
Ability to use personal computer and computer system software.
Effective oral and written communication skills are essential, as staff must be able to interpret and explain patient accounting information to patients, third-party payers and other general public.
Ability to learn and apply procedural guidelines, time utilization and solicit assistance when situations arise that deviate from the norm.
High school diploma required.
Course in medical terminology preferred
Successfully complete a six-hour, educational program that includes billing procedures, third-party payer requirements, contracts, problem solving techniques and other relevant materials.
Pass the open book competency test with a passing grade of 85 or better.