Patient Account Representative - Patient Financial Services

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Scheduled Hours:

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For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

Job Summary

Under general supervision and in accordance with established policy and procedure, is responsible for registration, verification, claim submission, follow-up, cash application, collection of accounts, appropriate referrals and assistance in selection and/or processing payment option assistance through Financial Counseling.

Essential Functions

Job Specific Contacts

1. General Contacts:
Telephone contact with patients and third party agencies (insurance companies). Corresponds with patients, family members, banks and other businesses, employers, physicians, hospital personnel, various employees of the Department of Social Services and Third Party vendor representatives. Department heads, supervisors.

2. Job Provides Direction to: N/A

D. Environment and Demands

1. Environmental Demands: Describe the physical environment in which the job must be performed.
Business office environment, hospital rooms, Department of Social Services. Requires light physical effort on a regular basis, as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items. Some minor physical inconvenience or discomfort routinely present in the work situation and occasional exposure to minor injury or other occupational hazards requiring Universal Precautions.

2. Essential Physical and Cognitive Demands, Manual Dexterity: Describe the physical efforts, manual dexterity cognitive skills required for the job (i.e., eye/hand coordination, lifting, pulling, walking, concentration, analysis, customer sensitivity, etc.). Requires light physical effort on a regular basis, as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items (i.e. up to 20 lbs.). Some irregularity in scheduled hours because of compensated overtime requirements, including weekend and/or other shift rotation. Interaction with patients and public.


B. MISSION/STRATEGIC PLAN:

Participates in activities which support the mission of the hospital


C. JOB SPECIFIC COMPETENCIES:

Demonstrates the required job specific technical/professional knowledge, skills and abilities. *

1. Works on assigned trial balance reports, concentrating on high dollars and aged accounts. Maintains account balance integrity.
2. Familiarizes oneself with the specific payer assigned contracts.
3. Establishes a good working relationship with insurance company contacts and demonstrates creativity in obtaining their assistance to ensure prompt adjudication of outstanding claims.
4. Researches EOBs received and takes appropriate action to maximize revenue.
5. Work closely with the admitting/verification department to identify and resolve process issues.
6. Requests medical records as needed, either resulting from a direct request from an insurance company or to submit an appeal and identifies clinical denials to immediate supervisor for Case Management, follow up/appeal.
7. Makes appropriate corrections as necessary to ensure the submission of a “clean claim” to the payor.
8. Receives and addresses all telephone inquiries and complaints to completion and utilizes appropriate resources to make informed decisions.
9. Documents all activities and actions taken in collection notes in an accurate and expeditious manner.
10. Work on registered accounts to verify the integrity of data captured during registration. Call patients when necessary to update data in billing system.
11. Update system with ins/demo information as indicated on data mailer returned from patient.
12. Satisfies requests from outside departments and entities (insurance carriers, physicians, attorneys, courts) to completion.
13. Displays positive job behaviors and telephone etiquette in all dealings with public.
14. Communicates with immediate supervisor to discuss problems, identify trends, and arrive at proper resolution.
15. Maintains appropriate logs, and reconciles all necessary detail.
16. Adjusts Accounts Receivable and Bad Debt accounts to the proper balance.
17. Researches credit balances or proper allowancing and/or refunds. Processes refund requests.
18. Performs special projects and other duties as assigned.

* Document on addendum age specific competency.


Part II: Employee Performance Standards

A. CUSTOMER SERVICE:

1. Demonstrates the ability to create a positive interaction with the customer.

2. Demonstrates positive communication with people of different cultures, values, and beliefs.

3. Demonstrates the ability to acknowledge customer concerns and takes corrective action.

4. Demonstrates compliance with identified customer service behaviors.

5. Provides escort to customers when necessary.


B. PERFORMANCE IMPROVEMENT:

1. Participates in Department/Hospital-wide activities which improve processes and/or outcomes.

2. Utilizes resources to maintain and improve self development and knowledge.

3. Complies with licensure and/or certification requirements.

4. Participates in annual competency assessment.


C. BUDGET:

1. Demonstrates fiscally prudent use of equipment and supplies.

2. Utilizes charge process for supplies/equipment.


D. PROJECTS/ASSIGNMENTS:

1. Completes projects/assignments within projected time frames and expectations.

Qualifications

• High School High School diploma or equivalent Required
• Clerical / Billing experience, PC / CRT experience preferred
• Excellent verbal and written communication skills