Lead Patient Representative

Lead Patient Representative

The Patient Representative is responsible for timely monitoring of the patient account from billing through final resolution. Through the process, the Patient Representative does follow up with insurance companies, assists with patient financial/billing questions, makes payment arrangements, and performs collection activities when necessary.

Minimum Qualifications:

• Education: High school diploma or equivalent required.
• Credentials: None

Physical Demands:

• Sit constantly.
• Stand/walk frequently.
• Lift floor to waist height 30 pounds occasionally; waist to waist 25 pounds occasionally; waist to overhead 20 pounds occasionally. And carry 10 pounds up to 25 feet occasionally.
• Reach overhead frequently standing and turn reaching shoulder height while sitting frequently.
• Fine motor coordination within normal limits for age and gender.
• Constant computer use.
• Visual acuity within normal limits.

Essential Functions:

• Work the system created work list to follow up on accounts the same day they appear on the work list.
• Answer incoming calls from insurance companies and patients, assisting them with any issues with resolution within 2 working days.
• Combine multiple patient accounts to one guarantor if requested by the guarantor and set up payment plans on patient balances.
• Ensure that follow-up and resolutions occur on patient account balances and provide customer service for patients. Follow-up on denied or partially paid claims. Resolve contractual differences with insurance companies for contracted plans.
• Communicates effectively to payers to ensure accurate and timely electronically filed claims as per department guidelines.
• Resolves patient complaints and requests regarding insurance billing and initiates accurate account adjustment. Follows all billing problems to conclusion. Manages department multi-line phone. Transfers calls as appropriate. Answers patient questions within prescribed guidelines.
• Review patient demographics and make changes as appropriate. Enter demographics as needed. Update patient insurance information to guarantee correct insurance billing.
• Ability to understand the components of remittance advices from various payers. A thorough understanding of the specific payment business rules for each type of insurance Medicare, Medicaid, Workers Compensations, Commercial insurance, etc.
• Submits all paper claims and supporting documentation as required by payers. Generate HCFA 1500 if needed. Print all paper claims and appropriate documentation to be sent to both primary and secondary insurance companies.
• Enter notes on the account, appropriately and timely, which would include claims information, issues, and general correspondence allowing anyone to understand the activity on the account. This would also include taking action on any correspondence with 2 days of receiving the correspondence and noting the action taken.
• Ability to manage account work-lists and daily mail within the prescribed time lines established for the department. Ability to document in the Practice Management System, in a clear and concise manner, the details of all interactions relative to a patient' account.
• Additional duties as assigned.

Join the dynamic team at Great Plains Health and be a part of something truly exceptional. At Great Plains Health, we embody a culture defined by authenticity, integrity, and a genuine commitment to listening to both our patients and each other. As a member of our team, you'll experience a supportive environment where collaboration is key, and every voice is valued. We work together seamlessly, leveraging our collective strengths to provide the highest quality care to our community. Passion drives us forward, propelling us to constantly strive for excellence in everything we do. If you're seeking a rewarding career in healthcare surrounded by like-minded individuals who share your dedication and enthusiasm, Great Plains Health is the place for you. Come join us and be part of a team that's making a real difference every day.