Senior Patient Accounting Representative

Description Position Summary

The Senior Patient Accounting Representative is a senior-level revenue cycle professional responsible for supporting the timely, accurate, and complete conversion of patient services into cash. This position performs complex billing, insurance follow-up, account resolution, denial management, and collection activities while serving as a subject-matter resource for Patient Accounting staff.

• Prepare, review, correct, and submit medical claims to insurance companies accurately and within established billing and timely-filing requirements.
• Review coded procedures, diagnoses, treatments, charges, demographic information, insurance information, and other claim components for billing accuracy and completeness.
• Maintain responsibility for achieving established organizational clean claim and first-pass acceptance targets
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• Identify and resolve claim edits, rejections, missing information, coding discrepancies, payer-specific requirements, and other issues preventing successful claim submission.
• Monitor rejected and returned claims and ensure corrections and resubmissions occur promptly.
• Analyze recurring claim errors and rejections by payer, provider, department, error type, and root cause.
• Communicate recurring issues to appropriate departments and management and recommend corrective actions designed to prevent future claim defects.
• Monitor billing data feeds and system interfaces for abnormal trends or conditions that may indicate potential billing errors or interruptions.

• Monitor assigned unbilled account inventory and take appropriate action to ensure accounts are billed as quickly and accurately as possible.
• Maintain assigned unbilled inventory within established organizational unbilled-days and/or DNFB targets
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• Identify coding, documentation, charge capture, registration, authorization, insurance, interface, system, or other barriers preventing accounts from progressing to final bill.
• Prioritize high-dollar and aging unbilled accounts for resolution.
• Coordinate with Patient Access, Coding, Health Information Management, clinical departments, providers, Information Technology, and other departments to resolve billing barriers.
• Escalate accounts and systemic issues that exceed established unbilled thresholds or cannot be resolved through normal processes.
• Quantify and trend recurring causes of unbilled accounts and recommend process improvements designed to reduce unbilled days.

• Actively manage assigned accounts receivable inventory to support achievement of the organization's established net days in accounts receivable target
  .
• Perform timely and effective insurance follow-up on unpaid, underpaid, denied, rejected, or otherwise unresolved accounts.
• Prioritize account activity based on age, dollar value, payer requirements, timely-filing limitations, denial risk, collection probability, and other established criteria.
• Maintain assigned accounts within organizational A/R aging targets
  , with particular emphasis on preventing and reducing receivables greater than 90 days.
• Research complex account balances and determine the appropriate action necessary to achieve payment or final account resolution.
• Contact payers as necessary to determine claim status, payment requirements, denial reasons, or additional information needed for adjudication.
• Document account activity completely and accurately in accordance with organizational standards.
• Escalate payer delays, systemic processing issues, and high-risk accounts when appropriate.
• Prevent avoidable timely-filing losses and unnecessary write-offs through effective account prioritization and follow-up.

• Maintain direct accountability for supporting achievement of established monthly cash collection targets
  .
• Manage assigned payer, account, or business-unit inventories to maximize reimbursement and accelerate cash collections.
• Monitor actual collections and account resolutions against established goals.
• Identify significant collection variances, determine contributing factors, and communicate findings to management.
• Identify opportunities to accelerate cash through focused payer follow-up, claim correction, denial resolution, appeals, rebilling, and escalation.
• Work collaboratively with management and other revenue cycle functions to address operational or payer issues negatively affecting cash collections.
• Support departmental and organizational initiatives designed to achieve or exceed established cash goals.

• Research and resolve claim denials, payment variances, underpayments, and other reimbursement discrepancies.
• Determine root causes of preventable denials and recommend corrective action.
• Prepare and submit appeals, corrected claims, reconsiderations, and supporting documentation when appropriate.
• Monitor recurring denial patterns and communicate findings to management.
• Quantify…