Under general supervision, the Patient Account Rep oversees collection of patient revenues, maximizing reimbursements, cash flow and maintaining low receivables, while also maintaining compliance with established state and federal regulations.
Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
Reviews patient accounts and follow-up documents to determine the nature and extent of delinquency problems, and any actions taken by patients or third party payers; investigates delinquency cases to identify any special circumstances affecting payment delays
Identifies and resolves problem issues independently.
Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
Stays informed of updated insurance requirements and reimbursement practices.
Assists with training of new staff members.
Promotes positive customer relations.
Compiles and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
Adjusts and rebills claims electronically or by paper to payers as required.
Processes appeal requests to insurance payer by obtaining complete medical records and completing required payer appeal forms.
Updates and corrects demographics, insurance and financial changes necessary to maintain accurate account information.
Reviews patient account with credit balances. Makes corrections, if needed and or submits refund request when appropriate.
Department Specific Competencies
Keeps informed of changing Medi-Cal and Medicare regulations.
Maintains advanced working knowledge of all sponsored programs such as Medicare, Medi-Cal, Tricare and all other payers; as well as contracted insurance payers and authorization requirements.
Maintains advanced knowledge of Medicare and Medi-Cal program requirements.
Maintains advance working knowledge of Medicare Secondary Payor Questionnaire policy and procedures.
Stays informed of updated insurance billing code changes and requirements.
Reviews claim scrubber and resolves claim edits.
High School Diploma/GED or Higher Education General Studies
Number of Years Experience Type of Experience
1 Hospital Business Office experience
Knowledge of admitting procedures/requirements. Knowledge of insurance billing procedures and requirements. One year experience in hospital business office.
License / Certification Requirements