Patient Account Representative

Patient Account Representative

1.0 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.

This 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.

The 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 Duties:

Claims Processing

• Knowledge of commercial and government payor regulatory requirements, timely filing guidelines and payment methodology
• Knowledge of claim forms – UB04, HCFA 1500, etc.
• Ability to research and resolve claim edits to release clean and timely claims for processing
• Provides feedback to analysts and/or leader when barriers arise in resolving claim edits preventing claims to release
• Meets and maintains quality and productivity metrics as well as Gillette CARES values as set by the department

Account Follow-Up

• Knowledge of and ability to accurately read EOB's
• Knowledge of CARC/RARC codes
• Demonstrates understanding and ability to apply patient account policies and procedures
• Follow 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 submission
• Follow up on delinquent accounts after 30 days of no response with payors by calling and/or utilizing payor portals for clarification on delays
• Files corrected claims when necessary using correct bill types/submission codes
• Works with peers and analysts as necessary to resolve claim issues
• Works with analysts and other departments to file claim appeals
• Processes hospital receivables in a timely and accurate manner
• Performs basic maintenance of patient accounts in EMR system as necessary
• Assessment 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 department

Technology, Policies and Procedures

• Demonstrates competency in organizational systems including: Cerner Revenue Cycle, Change Healthcare, eDOCS, online resources and other relevant technology
• Adheres to all organization and department policies, guidelines, and workflows to eliminate errors in practice
• Adheres to organization and department attendance policy
• Independently completes annual training as assigned
• Completes self-assessment timely and with contributing comments
• Completes 80% of peer feedback for direct peers

Qualifications:

Required:

• High School Diploma/ GED
• 1-3 years' experience in customer service, administrative or healthcare setting

Preferred:

• Advanced education (Associate or Bachelors)
• 2+ years of medical billing or coding experience that includes exposure to payor
• DME Billing Experience

Knowledge, Skills and Abilities:

• Knowledge & understanding of medical terminology
• Knowledge & understanding of commercial insurance carriers and standard insurance forms
• Strong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook)
• Demonstrated strength in customer service, organization, attention to detail and the ability to work independently
• Demonstrated ability to work and problem solve in a collaborative manner within the department and organization
• Demonstrated ability to multi-task and respond quickly/reprioritize changing needs

At 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.