Patient Accounts Representative

GENERAL SUMMARY:Under direct supervision, the Patient Accounts Representative I performs routine medical billing functions for third-party payers and ensures claims are completed accurately and timely. Review itemized bills to verify the accuracy and completeness of charges and research denied or incomplete bills. The Patient Accounts Representative researches and resolves patient complaints. May specialize in a general payer type or bill types such as Commercial, Government, Medicaid, Medicare, RHC providers, or Motor Vehicle Accident. This position may also be responsible for initial encounter data entry. This may include, but not limited to patient demographic entry, charge entry CPT-4 and ICD-10 coding and referrals to outside specialists. The Representative demonstrates excellence in customer service during interactions with employees, managers/supervisors, patients, patient family members, customers, insurance companies, etc. and works collaboratively with colleagues and departments throughout the organization to provide optimal care services in a professional, ethical and knowledgeable fashion. Maintains a safe, clean and organized work environment.Full-time benefits include medical, vision, dental, and prescription drug coverage, as well as HSA/FSA, life insurance, long-term disability insurance, retirement plans, and generous Paid Time Off.Minimum Education, Training & Experience (includes licenses or certifications):Education:High school diploma or GED required.Experience:At least two (2) years office/administrative experience required including: familiarity with everyday office equipmentOne (1) year experience working in medical billing, A/R or accounting is preferred.Essential Functions/Responsibilities (but not limited to):Edits bills to ensure accuracy and completeness, applying knowledge and understanding of Universal billing rules, regulations and claim form requirements.Reviews and completes necessary forms to ensure accurate billing.Checks patient demographic and insurance information. May be required to verify insurance for some claims.Ensures correct calculations; ensures any charge entries, charge corrections or transfers are processed per guidelines and systems.Follows up for missing information, bundling edits and/or diagnosis codes.Ensures proper physician names and provider numbers are listed.Documents billing history and data for A/R Management.Submits claims electronically or files hard copy claims as appropriate.Determines what supporting documents (e.g., Medical Records, Explanation of Benefits, and Itemized Bill) should be included with claims and obtained if needed.Reviews and completes daily unbilled reports, late charge reports and 72-hour reports; taking appropriate action on each claim to reduce billing delays and produce a bill.Rebills upon request after reviewing account notes and determining action to be taken.Reviews all patient accounts, on-line directly, to assure all claims are in process for payment, makes corrections/changes on rejected claims on-line.May determine whether a “split” bill is required and request proper billing.May process flag reports ensuring timely verification, rebill, and/or adjustment of claims based upon payer response.Provides accurate and quality Customer Service to internal and external customers regarding account status and pending actions.Answers all incoming telephone calls, voice mails, e-mails, faxes or personal requests in a professional manner.Interviews customers and assists appropriately.Works closely with providers, patients, and members of other departments.Sets deadlines for future action on accounts.Understands and applies the proper procedures for writing off adjustments of which the Representative is authorized to make. (Adjustment write-off authority varies according to specialty – may include Contractual, Routine, Bad Debt, Late Charges)Works effectively with large amounts of data and detail. Generates or works from multiple reports. Reports vary according to pay or specialty.Establishes secondary coverage status for Medicare insurance accounts to determine primary payment status of any other insurance.Checks and inputs information related to physician/provider status in the Medicaid system in order to maintain billing eligibility for treatment and care given to patients that have Medicaid insurance.Runs an insurance payment tickler report daily in the billing software system to determine account payments by insurance category and the aging of account status for payment; reviews report for establishing account status.Cross-train and provide coverage in other areas of the business office/patient financial services department as needed.Performs other duties as assigned. #J-18808-Ljbffr