Patient Account Representative
39000 Bob Hope Dr Rancho Mirage, California 92270
Works under the direction of the Billing Manager. Performs follow-up and collection of unpaid insurance claims including contracts and commercial carriers as well as self-pay accounts. Responsible for routine and timely follow-up until the insurance carrier correctly reimburses claims. Processes claim adjustments and refunds when appropriate and reacts to incoming mail and telephone calls regarding the assigned claims and patient bills. Responsible for updating, noting and maintaining the integrity of the account files.
1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
2. Manages new accounts, on a daily basis, by contacting payer to determine if the account has been received and/or if additional information is required. Assigns follow-up dates in accordance with follow-up guidelines.
3. Account resolution of all self-pay accounts including self-pay after insurance.
4. Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance
5. Works all accounts listed in the Follow-Up cue, on a daily basis to promote collection of accounts. This will include telephoning the payer or identifying the claim on the payers’ Internet location.
6. Manages entire account inventory on a timely basis to promote payment and resolution of all accounts prior to ninety days from date of billing.
7. Answers incoming telephone call from patients who call with questions/information regarding their bills
8. Responds appropriately to incoming mail from patients or payers regarding their assigned accounts
9. Processes incoming hard copy explanation of benefits and reacts appropriately to resolve the accounts.
10. Records accurate and definitive notes in the electronic account file that depict the current status of account, issues with account and anticipated date of resolution.
11. Escalates account management to manager when extraordinary issues arise.
12. Obtains and records “Promise to Pay” amounts on a daily basis that are consistent with the cash collection goals of the department
13. Assigns a status codes to each worked account to enable account tracking, statistical data gathering and audit activities.
14. Identifies work unit issues and participates in solutions and problem solving by working with manager and staff members.
15. Attends staff meeting, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines when requested
16. Performs other job related tasks as assigned by Supervisor
Prior experience in a clinic or hospital setting or 5 years experience in a clinic, payer or collection agency setting - Required
Strong Windows knowledge, keyboarding skills, knowledge of database system, and experience with internet applications - Required
Knowledge of computer based claims management - Required
Understanding of medical terminology -Required
Knowledge of billing regulations - Required
Working knowledge of managed care- Required
Some College - Highly Desired
Specific Skills, Knowledge, Abilities Required
1. Knowledge of computer based claims management
2. Strong windows knowledge, keyboarding skills, knowledge of database system and experience with internet applications
3. Able to operate basic office equipment i.e. copiers, fax machines and calculators
4. Must have an understanding of medical terminology
5. Requires strong customer service and problem solving skills
6. Requires the ability to handle multiple projects/tasks at the same time
7. Able to prioritize workload and possess good time management skills
8. Ability interpret contracts, billing regulations and complex claim requirements
9. Ability to lead and create motivated workers
1. Completes annual health, safety, compliance reviews and any department/hospital specific requirements within the expected timeframe.
2. Corrects and/or reports any unsafe conditions to extension 4759 or email@example.com.
3. Adheres to hospital and department safety and compliance policies and procedures.
4. Understands the importance of immediately reporting on-the-job injuries online and to your supervisor.
5. Wears identification badge at all times ensuring it can be read.
• CLINICAL/PROFESSIONAL EXCELLENCE
0. Accepts responsibility for own work; develops trust and credibility with peers, supervisors & customers.
1. Maintains sound judgment and reasoning; analyzes problems or procedures & selects correct course of action.
2. Treats co-workers as teammates; accepts/supports team decisions and the roles of others.
3. Monitors own work to ensure quality; participates in continuous quality improvement.
4. Engages in opportunities to learn and grow by participating in training and educational programs.
0. Acknowledges each person in a friendly contact & offers assistance as needed.
1. Provides an enhanced level of service by taking immediate action in addressing customer requests, needs, and concerns.
2. Uses pleasant/appropriate tone and positive verbal/nonverbal/written communication at all times.
3. Answers telephone by identifying department and name; and asks “How may I help you?”
4. Treats everyone with courtesy and respect, not making excuses nor blaming other employees or departments; works together to improve customer service.
• HEALING ENVIRONMENT
0. Maintains a professional image and a clean, orderly environment that portrays an overall image of excellence.
1. Promotes a culture of healing by creating a quiet, calm, pleasant and cheerful environment.
2. Demonstrates compassion when dealing with difficult situations & takes initiative to resolve.
3. Creates a positive environment by not engaging in inappropriate communication.
4. Demonstrates a positive, can-do attitude and embraces the culture of performance excellence.
0. Adheres to all hospital, division and departmental policies and procedures.
1. Balances individual/team responsibilities to produce more efficiently. Helps others during slow periods.
2. Adheres to all rules & standards around productivity, timeliness, overtime, & meal/rest periods.
3. Provides helpful, courteous, timely, and accurate responses to all individuals & pays attention to detail.
4. Makes a concerted effort to conserve hospital resources, i.e. electricity, supplies, water.
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