Patient Account Representative

Job Description

The Patient Account Representative (PAR) is responsible for the timely and accurate processing of patient accounts receivable billing and collections. The specific job duties will be comprised of a combination of responsibilities from among the various areas of PFS operations including Charge entry and charge batchbalancing, Electronic and hardcopy claims editing and submission to various payers (Government, Managed Care, and Commercial), Accounts receivable collections and payer follow-up, Payer denial review and appeals processing, Customer service, Payment applications, Credit balance review and resolution and Patient advocacy and risk management. Under initial close supervision, performs simple, often repetitive and routine duties. Responds to simple queries/issues, but recognizes deviation from accepted practice and refers non-routine issues to others. Works on assignmentsthat are routine in nature where limited judgment is required. Normally receives detailed instructions on all work.

What you will do:

• Account Reps: Follows up on unpaid accounts in patient accounting systems with the payers either by phone or via websites. Works payer denials based on claim process adjudication; Review accounts for possible underpayments; research contracts, guidelines and resolve payment with payer. Perform appeals with payer.

• Performs bad debt request transfers as applicable. Performs or requests adjustment and contractual write offs as applicable

• Billers: Reviews EPIC worklists and edits accounts as needed; Reviews Cirius claim edits and resolves edits; Reviews and resolves electronic acknowledgement payer rejections/denials; Rebills claims based on requests from Follow Up reps due to denials received. Resends claim as needed.

• Cash Posting Reps: Posts payments; Work EPIC undistributed payment worklist; Posts adjustments related to payments. Processes refunds for accounts payable. Posts payment transfers from professional billing to hospital billing

• Data Control Reps: Enters charges; Reviews EPIC worklist accounts with charge issues and resolves;

• Researches charge issues and follows up with departments as needed. Complete charge corrections including adding diagnosis, transferring or reversing charges, combining accounts.

• Maintains professional communication with various PFS staff, medical center staff, payors, physicians, and patients regarding the billing of services rendered . Communication may consist of telephone, correspondence, or in person contact.

• Meets weekly individual productivity goals and standards while following planned priorities as set by the Team Manager/Coordinator.

• Patient Advocacy Reps: Completes and processes charity applications; Reviews and validates high dollar self pay accounts before outsourcing to outside vendor; Handles patient calls and complaints. Requests referral of accounts to bad debt as applicable

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to View email address on click.appcast.io learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

: Microsoft products (such as Outlook, Excel)

• Must have skills: strong communication skills, Excel, as well as the below from the PAR job description:

o Ability to follow oral and written instructions and interpret institutional and other policies

o accurately.

o Ability to gather, analyze, and display data in appropriate format and keep accurate records.

o Ability to maintain confidentiality of sensitive information

o Ability to perform basic mathematics

o Ability to plan, prioritize and meet deadlines

o Ability to work effectively with individuals at all levels of the organization

o Knowledge insurance and medical terminology

o Knowledge of accounts receivable system (such as Epic)

o Knowledge of computer systems and software used in functional area

o Knowledge of medical reimbursement policies and procedures

o Knowledge of one or more of the following: Medicare, Medi-Cal, Worker's Comp or Managed

Care (HMO,PPO,POS, etc)

o Knowledge of principles and practices of customer service and telephone courtesy Epic charge entry, WQ knowledge, quick ten-key