Patient Account Representative 4 - Hospital

The Patient Accounts Representative 4 performs an important function in the revenue cycle of the Health System. This role is production based and works an assigned queue to coordinate with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and professional charges. The Patient Accounts Representative is responsible for the customer service, billing and collection functions in the Business Office. Key tasks include reviewing accounts on EPIC system, providing information requested and applying critical thinking to resolve issues between balances and/or credits belonging to managed care vs the patient. This role responsible for collections on delinquent insurance and patient balances and for working credit balance reports, posting payments and adjustments, and filing claims and appeals denials with managed care companies. Must meet minimum performance and quality measures. This role is leverages years of experience to handle more complex scenarios and provides SME support to other team members, as well as collaborating with leadership to identify opportunities for improvements.

Responsibilities

1. Execute Business Office Operations and Functions
   1. 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.
   2. 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.
   3. Leverages contract knowledge and expertise to drive revenue
   4. 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
   5. 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
   6. Identifies patterns, trends in account issues and escalates as appropriate so root cause can be addressed and improved.
   7. Maintains subject matter expertise on regulations, process and policies by attending training and applying in daily work
   8. Consistently meets production and quality requirements for area, driving overall department objectives for A/R, Claim Counts and past dues.
   9. Responds to requests (from customers, co-workers, management) in a timely and professional manner.
2. Planning and Support
   1. Assists with planning and participates in internal and external meetings as a representative of department
   2. Serves as a subject manager expert to other team members.
   3. Provides training / shadowing support for new team members
   4. Identifies areas for improvement or fixes to system edits / processes and communicates to appropriate owner to resolve issues
   5. Collaborates with Payor Relations and Vendors over contract issues; researches Payor issues, coordinate to resolve payment and reimbursement issues
   6. Creates & updates workflows, using SME knowledge and insight on trends identified to drive process improvements
3. Other Duties as Assigned
   1. Leads special projects / updates

Qualifications

• 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.
• High School diploma or equivalent
• 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.