Patient Account Representative

JOB SUMMARY

The Patient Account Representative’s responsibilities include liaising with medical insurance providers to process claims in a timely and accurate manner, resolve payment issues, assist patients in understanding insurance claims, and processing patient payments and refunds.

To be successful as a Patient Account Representative, one should be detail-oriented and knowledgeable of medical terminology and billing. Ultimately, an outstanding Patient Account Representative should demonstrate exceptional communication skills necessary to work effectively with insurances and patients in processing accounts in a timely and accurate manner.

DUTIES AND ESSENTIAL JOB FUNCTIONS

This job description covers or contains a listing of most activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

• Work accounts receivable assignments efficiently and timely while maintaining expected performance goals.
• Identify problem accounts with payers by investigating, analyzing, and correcting errors
• Conduct follow up on outstanding accounts by calling insurance companies or utilizing the payer web portals. Properly documents detail notes on every account preparing for the next course of action and or resolution
• Research denied claims as well as underpayments from third party payers and processes appeals and/or claim(s) reconsiderations to insurance companies in a timely manner
• Ability to identify trends and repeated problems and report them to management for evaluation
• Process patient payments and refunds.
• Work with insurance companies to determine benefits for procedures, surgeries, and clinic services in order to estimate patient’s financial responsibility.
• Ability to analyze and understand written communication from insurance companies and other third parties, including but not limited to, explanation of benefits, correspondence, and requests for additional information to process claim(s) in a timely and accurate manner.
• Contact patients and collects prepayments and outstanding balances.
• Interacts with patients when eligibility and benefits cannot be verified through the various payer portals, etc.
• Interacts with patients to assess eligibility for financial assistance programs/grants and assists them with the application process(es).
• As appropriate, obtains prepayment(s)/payment arrangement(s) for patients receiving cancer therapy, other USA services, and outstanding balances.All other reasonable duties, as assigned.

COMPETENCIES

• Customer Service - Manages difficult or emotional customer situations, responds promptly to customer needs, solicits customer feedback to improve service, responds to requests for service and assistance, meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming, maintains confidentiality, listens to others without interrupting, keeps emotions under control, remains open to others' ideas, and tries new things.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations, listens and gets clarification, responds well to questions.
• Written Communication - Writes clearly and informatively, able to read and interpret written information.
• Teamwork - Exhibits objectivity and openness to others' views, gives and welcomes feedback, contributes to building a positive team spirit.
• Diversity - Shows respect and sensitivity for cultural differences.
• Ethics - Treats people with respect, keeps commitments, inspires others' trust, works with integrity and ethically, upholds organizational values.
• Organizational support - Follows policies and procedures, supports the organization's goals and values.
• Planning/Organizing - Prioritizes and plans work activities, uses time efficiently.
• Professionalism - Tactfully approaches others, reacts well under pressure, treats others with respect and consideration regardless of their status or position, accepts responsibility for own actions, follows through on commitments.
• Quantity - Meets productivity standards, completes work on time, strives to increase productivity, works quickly.
• Safety and Security - Observes safety and security procedures.
• Adaptability - Adapts to changes in the work environment, changes approach, or method to best fit the situation and deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality - Consistently at work and on time, ensures work responsibilities are covered when absent, and arrives at meetings and appointments.
• Dependability - Follows instructions, responds to management direction, takes responsibility for own actions, keeps commitments, commits to long hours of work when necessary to reach goals, completes tasks on time, or notifies appropriate person with an alternate plan.
• Initiative - Volunteers and readily seek increased responsibilities, look for, and takes advantage of opportunities, asks for, and offers help when needed.
• Innovation - Displays original thinking and creativity, meet challenges with resourcefulness, generates suggestions for improving work.

OTHER SKILLS AND ABILITIES:

• Remain calm and professional in stressful situations.
• Friendly, courteous, service-oriented, and flexible and enjoy working with a variety of staff.
• Detail-oriented and work effectively under pressure while meeting all applicable deadlines.
• Must be able to work independently and productively with minimum supervision, able to manage multiple projects.
• Recognize problems, identify possible causes, and resolve routine issues.
• Establish and maintain effective working relationships with internal and external organizations, groups, team members, and individuals.

QUALIFICATIONS

Required

High school diploma or general education degree (GED) and one (1) year related experience in a medical office or hospital setting with experience processing professional fee claims

Preferred

CPT-Coding/Billing, Continuing Education Coding classes

Knowledge of medical terminology and office billing

Knowledge of electronic medical records (EMR), patient management (PM) system(s), insurance payer portals, and clearinghouse(s) is necessary to utilize these resources to work assigned tasks and responsibilities effectively