Patient Account Representative II

Senior Patient Account Representative

The Senior Patient Account Representative is responsible for billing, follow-up and collections of hospital patient accounts receivable. This position is responsible for submitting clean electronic and paper claims to payers, communicating over the phone with internal and external contacts to resolve issues, providing information and taking payments. This position will be expected to use assertive follow-up techniques with third-party payors for claim resolution including incorrect payments or denials.

Position Requirements

• Licensure/Certification/Registrations: None
• Education: High School Diploma or equivalent required.
• Experience: 2-3 years of healthcare accounts receivable experience required. Previous experience in a hospital setting with insurance billing and follow-up, contractual adjustments, Medicare/Medicaid and managed care is strongly preferred. Knowledge of Epic EHR preferred.
• Skills & Abilities: Excellent organization and customer service skills. Ability to successfully handle multiple priorities and prioritize and schedule accordingly while meeting established deadlines. Must be able to successfully and effectively communicate with a variety of personnel. Advanced communication skills, both verbal and written required. Ability to maintain a high degree of accuracy, demonstrate dependability and a strong attention to detail. Possess the ability to think independently, problem solve and adapt in an environment that presents multiple variables and circumstances. Strong proficiency in Microsoft Word and Excel, web navigation and understanding of patient accounting systems required.

Essential Functions

• Ensure proper billing of patient accounts and ensure all account receivables are monitored and third-party payors and patients are contacted to collect outstanding balances
• Monitor contracts and individual patient agreements to ensure appropriate reimbursement is received in a timely manner.
• Ensure timely filing requirements are met and claims are followed up on in a timely and appropriate manner to eliminate timely filing denials and non-payment of claims.
• Follow up on denials in a timely manner and proactively communicates any denial issues related to billing requirements.
• Follow up on unpaid/unresolved account balances as required in the work queue and notates follow-up response on patient accounts.
• Complete resubmission of claims, corrected claims, medical records requests and appeals as necessary to facilitate timely and proper claims payment.
• Effectively communicate and collaborate with Clinical Case Managers, Health Information Management, Admissions and other hospital departments for account-related issues.
• Investigate and respond to billing and collection inquiries of a complex nature. Answer inquiries and correspondence from patients and insurance companies to facilitate payment and makes necessary corrections to ensure claims payment.
• Post payments and/or appropriate notes to patient accounts; processes contractual adjustments, credit balances and refunds; research and resolves payment problems; enter data to and operates on-line computerized patient accounting systems.

Position Responsibilities/Duties

This section is meant to provide an employee with a summary of major responsibilities and duties that they may be expected to complete in this position. The following duties ARE NOT intended to serve as a comprehensive list of all duties performed by employees in this position. Employees may be required to perform additional duties not listed in this section.

• Monitor all self-pay accounts & balances. Demonstrate understanding of the various "Self Pay" account classifications and their applicable patient statement processes. Review all self-pay balances with credit balances to ensure the balance is accurate.
• Responsible for any special projects related to obtaining appropriate reimbursement of claims and Medicare bad debt write-offs.
• Identify and resolves patient billing complaints and explain charges, EOBs and payments
• Prepare and process UB04 and 1500 claim forms and itemized statements for billing to various insurance companies based on contractual requirements.
• Maintain current and accurate information in patient accounting system.
• Maintain spreadsheets for accurate reimbursement verification.
• Document all actions related to billing and collection functions in patient accounting system.
• Process account payments.
• Review EOB's to ensure accurate contractual reimbursement.
• Process miscellaneous correspondence and take action as necessary
• Post contractual adjustments.
• Follow progress of claims and initiate contact to payers to determine status of unpaid claims.
• Compose appeal documents as needed for claim disputes or payment.
• Scan account-related documents in patient accounting system or document management system.
• Communicate with consulting physician offices.
• Resolve credit balances as required by work queue.
• Provide requested billing record to Health Information Management.
• Prepare medical record requests as needed for billing.
• Become familiar with and follow hospital-wide and department-specific policies and procedures; seeking assistance from management when clarification or assistance as needed
• Assisting other staff members as requested.

** This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.

Craig Hospital Benefits:

At Craig Hospital we offer a wide range of outstanding benefits that allow our employees to tailor a benefits package that meets their individual needs. Planning a family or looking forward to retirement we have options. Our medical insurance is a self-funded plan administered by Allegiance Benefit Plans with a CIGNA network of providers offering two different comprehensive plans. We offer dental insurance through Delta Dental, and vision insurance through EyeMed. Craig offers Health Care and Dependent Care Spending Accounts. Craig also provides, and pays for both Short Term and Long Term Disability Insurance plans for every benefit-eligible employee. We offer generous time-off benefits to allow you to enjoy your time away from work too! Additionally, we have a 403b Retirement Plan with a generous matching contribution through Empower Retirement that you are eligible for upon hire. Want to go back to school? We have Tuition Assistance. Unexpected emergency? We have Employee Assistance Programs and an Employee Emergency Assistance Fund.

At Craig we believe in offering best-in-class benefits and prioritize benefits to support you.