Patient Account Representative to Outpatient

Patient Account Representative- Outpatient

We are dedicated to creating an environment of care and engagement that makes us one of the most desirable places to work, providing exceptional care to each patient each and every day!

Qualifications:

• Bachelor's Degree required, commensurate experience will be considered.
• Knowledge of third party collections and reimbursement.
• Two years hospital or medical business office experience, or comparable experience with third party or collection agency.
• Excellent verbal, communication, organizational, interpersonal and analytical skills.
• Experience with healthcare financial systems and Microsoft Word, Excel & Outlook is required.
• Familiarity with medical terminology preferred.
• Ability to manage multiple projects and priorities while meeting deadlines preferred.

Job Summary:

• Responsible for the accurate billing, timely preparation and claim submission of assigned accounts. Performs regular analysis of accounts to determine collectability and implements appropriate collection, adjustment, or write off procedures to settle accounts. Collaborates with outpatient clinical departments to resolve account issues. Reports inconsistencies and trends to management. Accepts incoming customer service calls from Patients, Patients Families, Attorneys and other professionals.

Physical Demands:

• This position requires walking, standing, and sitting with the ability to lift/carry and push/pull up to 20 pound frequently. This position also requires frequently looking at a computer and using a telephone for extended periods of time. This position also requires the ability to bend, squat, balance, reach above shoulder height and twist frequently. The ability to touch, see, and hear are required continuously with gross grasp and fine manipulation. This position frequently changes position moves from one area of hospital to another occasionally stands for extended period of time. Frequently works in crowded, noisy environment.

Cognitive Demands:

• This position requires high levels of independent judgement/ problem solving, written expression/ communication, verbal expression / communication, reading / auditory comprehension and computation skills. Adjust schedule to adapt to changing priorities. Initiates work independently; accesses resources and can handle multiple responsibilities simultaneously.

Work Demands:

• This position requires the ability to work under a variety of conditions that includes moderate noise and frequent interruptions. Adjust work hours and schedule to changing priorities in the department. Works both independently as well as a team. This position requires occasional overtime on an as needed basis.

Essential Functions:

• Demonstrates a thorough understanding of third party coverage and reimbursement for accurate billing and payment. Maintains working knowledge of all hospital contracts and their relevant procedures and guidelines. Reviews potential risk applications with Team Lead and/or Manager of Patient Accounts & Reimbursement. Keeps Team Lead apprised of unusual activity on a daily basis.
• Communicate any concerns relating to patient registrations via the established methods by department (ie. shared file, email, etc). Report to Manager od Patient Accounts & Reimbursement on any outstanding unworked account concerns after 3 weeks.
• Daily claim edit review & submission is the responsibility of the Claims Analyst. Responsible for understanding the process of claim submission and maintaining the ability to cover for the Claims Analyst if necessary. Coverage includes, mailing paper claims and submitting secondary claims (manual and electronic).
• Responsible for timely follow-up on assigned accounts and initiation of appropriate collection procedures as required and as defined by policy. Demonstrates a thorough understanding of hospital account receivables. Uses the A/R reports and worklists to place collection emphasis on balances over 90 days. Concisely document all efforts in hospital accounts receivable system.
• Utilize hospital contracts and reimbursement policies to ensure appropriate adjudication of accounts. Demonstrates a strong understanding of system contractual allowances and impact on accounts receivable. Review account activity through the use of payment report, collectability report or similar reports to identify contractual or payment variances. Analyzes identified variances and implements appropriate rebilling and/or adjustments accurately and efficiently.
• Maintains appropriate working knowledge of the accounts receivable system, demonstrates effective usage that maintains accuracy of billing and increases timeliness. Notifies management of any variations in system functionality that affect workflow.
• Reviews accounts quarterly to report on the potential collectability of each. Recommends additional reserve adjustments if appropriate. Analyzes and resolves credit balances on a continual basis.
• Follows up on adjudicated denials. Coordinates appeals with clinical department leadership and documents all efforts in the hospital AR system. Collaborates with the OP Authorization and Charge Capture Specialist to ensure appeals are submitted timely.
• Expected to collaborate with other Patient Account Representatives on a daily basis and support one another when needed. Participates in case concerns with clinical staff when requested. Compiles documentation requested for year-end audit, payer audits, and internal audits as requested. Assists management with targeted projects as needed.

Hospital for Special Care