Patient Account Representative Lead - Pre-Visit Services/Authorizations

Position Title:

Patient Account Representative Lead - Pre-Visit Services/Authorizations

Department:

Pre-visit Services

Job Description:

New to OU Health? Ask your recruiter about our competitive wages and total rewards package.

Remote Eligibility: Candidates must reside and work full-time in OK before their first day of employment.

SHIFT: M-F, Days. Will be required on-site as needed, at least monthly.

**The ideal candidate will have leadership experience, as they will be the subject-matter-expert for their small team when it comes to processing authorizations and referrals. Minimum of 3 years in authorizations is preferred.**

General Description: Under general supervision, may participate in any or all aspects of the patient processing and accounts receivable functions of the organization including billing, charge entry, collection, registration, scheduling, follow-up, coding, payment posting and credit balance resolution. May reconcile daily IDX system receivables reports. May balance monthly transactions and provide summaries to faculty and department administration.

Essential Responsibilities:

Patient scheduling

Patient registration

• Review patient admitting records and extracts relevant information
• Records patient identification and demographic information in the computerized billing system
• Contacts agency representatives to verify type and extent of coverage.

Charge entry

• Performs preliminary review of source documents to determine that sufficient data are present for processing
• Using alphanumeric keyboard, transcribes and/or verifies data from source documents to the medium used for entering data into the computer
• Batch charges
• Generate cash totals
• Enter charges
• Balances batches by comparing batch proofs to source documents and hash totals

Billing

• Works with all areas of the organization in getting any necessary or requested documentation for patients, insurance carriers or other areas.
• May interact with hospital patient accounting or records personnel to obtain patient demographic or other billing information
• Operates hospital information system terminal to obtain patient demographic information, patient insurance information and status of approvals or denials
• Completes processing of all inpatient and outpatient documents received on a daily basis
• Assists in resolving department problems with IDX billing
• Maintains records of charges, payments, third party charges, etc.

Collection

• Answers patient's questions regarding statements, agency coverage, etc.
• Handles correspondence regarding collection activity and records results
• Identify patient accounts for collection action when accounts become delinquent or when unable to contact patient or responsible party
• May receive patient payments and/or issue payment receipts

Coding

• Record CPT codes on billing forms
• Record ICD-9 codes on billing forms

Follow-up

• Initiates contact with patients and/or third party carriers if there is a delay in responding to statements or claims
• May process incoming and outgoing mail
• May receive incoming telephone calls and resolve issues communicated
• Records results of mail and telephone contacts on the computer billing system
• Contacts insurance carriers regarding non-payment and/or improper payment of claims
• Reviews denials
• Interfaces with patients, physicians, and others regarding professional billing operations and funds

Payment posting

• Post receipts to proper patient accounts
• Posts denials
• Compare batch proofs and source documents for accuracy

Reporting

• Assists in reviewing and balancing IDX transaction reports for administration
• Reconciles daily IDX receivables reports
• Prepares billing statements from statistical data

Credit balance resolution

• Review daily billing and accounts receivable credit balance reports
• Prepare daily refund check requests
• Prepare other daily credit balances other than refunds
• Post refund checks to patient accounts
• Mail refund checks with supporting documentation

Personnel Supervision .

• Leads and trains employees.

General Responsibilities:

• Performs other duties as assigned.

Minimum Requirements:

Education: High School Diploma or GED.

Experience: At least 5 years of experience in Medical Billing, Medical Collections, Medical Billing Systems (IDX or other billing system) required.

Licensure/Registrations/Certifications Required: None required.

Knowledge, Skills & Abilities:

• Proven ability to manage a team of professionals and lead a departmental function
• Excellent verbal and written communication skills
• Proficient with the use of Microsoft Office tools

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