Medical Billing - Patient Account Representative

SUMMARY 

The Patient Accounts Representative is responsible for providing support to the billing department manager. The position’s goal is to maximize cash inflows through billing and collecting for the services the company provides, while maintaining compliance with all applicable laws and regulations. The position will be responsible for all insurance follow-up activities with payors in a courteous and timely manner.

Representatives will process patient accounts to third parties and resolve accounts to a zero balance. Expertise in all third-party billing and contracted payment agreements. The account representative is required to have good writing skills and ensure proper account documentation. Verbal communication required for relaying issues/concerns with problem accounts to supervisor and mangers.

DUTIES AND RESPONSIBILITIES · Verification of financial responsibility to accurately bill the correct party. · Accumulating additional information as necessary to substantiate the medical necessity of the transport. · Data entry into the computer system. · Printing, auditing, and disbursement of paper and electronic bills and claims. · Follow up calls and letters to insurers, individuals, and third-party payers to ensure timely remittance of their obligations. · Coordinating payment plans with patients and their representatives for the non-covered, or self-insured portion of their charges. · Appealing denied claims with additional documentation of medical necessity. · Documentation of process into the patient account computer record. · Maintenance of the patient medical and billing records. · Maintenance of files relating to correspondence. · Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies. · Reports productivity results daily to the department supervisor. · Works minimum standard number of accounts per payer per day. · Meets or exceeds collection goals by payer each month. · Works all assigned accounts at least once every 15 or 30 days, depending on balance. · Participates in educational activities and attends department staff meetings. · Maintains confidentiality: adheres to all HIPAA guidelines/regulations. · Assistance with incoming calls, subscription program, and the general operations of the business office including on-site customer service for billing activities. · Work with others within the department and other departments; helps others and is willing to assume additional work, new responsibilities or perform other jobs when needed. · Train and cooperate with fellow employees, share information, knowledge, and skills. · Other duties as deemed necessary.

MINIMUM QUALIFICATIONS

Education and Experience

High School Diploma or equivalent required.

Minimum of two (2) years of experience in medical billing, patient accounts, insurance follow-up, revenue cycle management, healthcare customer service, or a related healthcare administrative role required.

Three (3) to five (5) years of medical billing experience preferred.

EMS billing experience preferred.

Working knowledge of Medicare, Medicaid, commercial insurance, healthcare reimbursement methodologies, claims processing, and account resolution processes preferred.

Intermediate proficiency in Microsoft Word, Excel, and other computer-based business applications required.

Familiarity with medical terminology, ICD-10 diagnosis coding, Fair Debt Collection practices, and healthcare privacy regulations preferred.

Skills and Proficiencies

Demonstrated ability to read, interpret, and apply information contained in Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), payer correspondence, and denial notifications.

Ability to identify denial reasons, contractual adjustments, patient responsibility, reimbursement discrepancies, and appropriate account resolution actions.

Ability to investigate and resolve Coordination of Benefits (COB) issues, including determining primary and secondary payer responsibility, obtaining updated insurance information, and facilitating proper claim submission and reimbursement.

Ability to analyze account activity, research billing issues, identify payer-specific requirements, and determine appropriate follow-up actions.

Demonstrated ability to communicate professionally and effectively with patients, insurance representatives, healthcare facilities, attorneys, and coworkers in both routine and difficult situations.

Accurate typing of at least 30 words per minute.

Highly proficient in the use of computers, business software applications, and web-based payer portals.

Ability to learn and apply company policies, billing procedures, payer regulations, and Accounts Receivable system functionality.

Ability to accurately document account activity, maintain detailed records of actions taken, and follow established billing procedures with minimal supervision.

Ability to work effectively in a production-driven environment while meeting established quality, attendance, and productivity standards.

Dependable in both attendance and performance.

Certifications

None required.

Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or similar healthcare revenue cycle certification preferred.

Physical Requirements

Occasionally: Walking outside, lifting, pushing, pulling, reaching, balancing, carrying, kneeling, stooping, bending, leaning, sitting, flexibility, driving a vehicle.

Frequently: Touching, typing, climbing, and performing multiple physical activities simultaneously.

Constantly: Hearing/listening, clear speech, walking inside, seeing.

Working Conditions

Constantly: Works alone, with others, around others, face-to-face and verbal contact with others, extended periods of computer use, and indoor work environment.

Mental Requirements

Constantly: Simple and complex reading and writing, clerical functions, memorization, analysis, perception/computation, problem solving, simple mathematical calculations, judgment, reasoning, and decision making.

EQUIPMENT USED Constantly: Telephone recording equipment, facsimile, computer/typewriter, keyboard, telephone, copy machine, stapler, 3-hole punch, stamping, sharpener.

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees are required to follow any supervisory instructions and to perform duties as requested by the supervisor and /or other management personnel from time to time.