Patient Account Rep - Hospital - Day Shift

Job Description

The Patient Accounts Representative 2 works with patients, co‑workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and/or professional charges. The Patient Accounts Representative 2 is responsible for the monitoring of patient accounts which includes, but is not limited to: claim submissions, researching and reviewing back‑end denials; determining appropriate action for submission of provider claims; outbound and inbound calls from insurance carriers, providers and patients;

payment posting; collections; account adjustments and appeals.

• Customer Service Promptly answers inquiries from patients, co‑workers, and employees regarding patient accounts in a kind and courteous manner.
• Assists in providing quality training and orientation for assigned employees.
• Payer Relations Advises patient or guarantor of third‑party payer benefits and estimated private payer amount and collects partial payments prior to admission in a manner that promotes the provision of high‑quality health care services by the department.
• Reviews patient papers and documentation for reported information accuracy, researches errors on patient accounts, billing and insurance problems, and lost payments to ensure accurate record maintenance and prudent departmental operation.
• Makes written and verbal inquiries to third‑party payers, reconciles patient accounts, and makes payment arrangements in an effort to ensure that patients are free from financial burden and that patient interests are appropriately represented.
• Coordinates and originates payroll deduction actions for hospital employees in accordance with established policies and procedures, and oversees collection letter mail‑outs for delinquent unpaid patient accounts in a prudent and efficient manner.
• Sends itemized patient account statements per attorney request or in response to subpoena in a professional and diligent manner.
• Reviews claims to make sure that payer‑specific billing requirements are met.
• Follows up on claims, determines and applies appropriate adjustments.
• Updates accounts.
• Receivables Works with external agencies and companies to provide patients with prompt reimbursement for hospital services. Interprets, explains, and counsels patient and family regarding hospital charges, services, and payment policies in a manner sensitive to the needs and financial situation of the patient.
• Quality Maintain a quality accuracy average of 95% and a production set by management for specialty focus. Thoroughly completes assigned tasks within the requested timeline.
• Other Duties As Assigned Performs other duties as assigned or requested.

• Must have 2 years of relevant experience. A Bachelor’s Degree substitutes for 2 years of experience; an Associate’s Degree, trade school, or certification substitutes for 1 year of experience.
• Relevant experience examples include LPN, RN, Revenue Cycle, Accounting, Bookkeeping, Business, Billing, Coding or call center environments.
• High School diploma or equivalent.
• Must possess knowledge of ICD‑9/10, CPT and HCPCS coding, accurate data entry skills, and the ability to answer multiple phone lines with incoming and outgoing calls.
• Must understand the explanation of benefits of various managed care companies and be able to demonstrate teamwork and willingness to work in cooperation and support of others as well as comply with FMOLHS policies and procedures.