Patient Account Representative

Job Title1.0 FTE (40 hrs/wk); Monday – Friday, business hours. This position requires initial on-site training at the 455 Phalen location in St. Paul, and then will transition to a remote working role. However, the selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed.Purpose of PositionThis position provides support for recovering back-end revenue by ensuring timely and accurate processing of patient accounts to both third party payors and patients/guarantors. Promotes and maintains professional and positive patient and family experience as the last impression of the organization.Claims Processing: Responsible for resolving front end claim edits to ensure accurate and timely clean claim submission to third party payors for adjudication.Account Follow-Up: Follows up on outstanding patient accounts to clarify reason or delayed and/or delinquent processing and resolving technical denials to ensure accurate and timely processing in order to reconcile outstanding balances.Additional responsibilities are defined as those specific duties relating to the various revenue cycle functions as assigned by the Revenue Cycle Practice Manager, Team Goals, and Organizational job performance standards.Compensation & BenefitsThe hourly wage for this opportunity is $21.88/hour to $30.87/hour, with a median wage of $25.74/hour. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for 0.5 FTE and above.Core Responsibilities and DutiesClaims ProcessingKnowledge of commercial and government payor regulatory requirements, timely filing guidelines and payment methodologyKnowledge of claim forms – UB04, HCFA 1500, etc.Ability to research and resolve claim edits to release clean and timely claims for processingProvides feedback to analysts and/or leader when barriers arise in resolving claim edits preventing claims to releaseMeets and maintains quality and productivity metrics as well as Gillette CARES values as set by the departmentAccount Follow-UpKnowledge of and ability to accurately read EOB'sKnowledge of CARC/RARC codesDemonstrates understanding and ability to apply patient account policies and proceduresFollow up on claims submitted to payors for adjudication to ensure claim has been received and in process for payment or denial within 30-45 days of claim submissionFollow up on delinquent accounts after 30 days of no response with payors by calling and/or utilizing payor portals for clarification on delaysFiles corrected claims when necessary using correct bill types/submission codesWorks with peers and analysts as necessary to resolve claim issuesWorks with analysts and other departments to file claim appealsProcesses hospital receivables in a timely and accurate mannerPerforms basic maintenance of patient accounts in EMR system as necessaryAssessment of outstanding balances for assigned accounts to determine proper course of action for obtaining payment and reconciling balance.Meets and maintains quality and productivity metrics as well as Gillette CARES values as set by the departmentTechnology, Policies and ProceduresDemonstrates competency in organizational systems including: Cerner Revenue Cycle, Change Healthcare, eDOCS, online resources and other relevant technologyAdheres to all organization and department policies, guidelines, and workflows to eliminate errors in practiceAdheres to organization and department attendance policyIndependently completes annual training as assignedCompletes self-assessment timely and with contributing commentsCompletes 80% of peer feedback for direct peersQualificationsRequired:High School Diploma/ GED1-3 years' experience in customer service, administrative or healthcare settingPreferred:Advanced education (Associate or Bachelors)2+ years of medical billing or coding experience that includes exposure to payorDME Billing ExperienceKnowledge, Skills and Abilities:Knowledge & understanding of medical terminologyKnowledge & understanding of commercial insurance carriers and standard insurance formsStrong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook)Demonstrated strength in customer service, organization, attention to detail and the ability to work independentlyDemonstrated ability to work and problem solve in a collaborative manner within the department and organizationDemonstrated ability to multi-task and respond quickly/reprioritize changing needsAt Gillette Children's, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential.Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws.Gillette Children's is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.