Patient Account Representative

Qualifications

• High School Diploma or GED (Required)

• 2 - 3 years a structured business environment (Required)
• 2 - 3 years hospital, Physician office or insurance environment (Preferred)

• Required Certifications/Licensures:
• CPAR certification or must be obtained within two years of employment

• ATTENTION TO BILLING DETAIL - PATIENT ACCOUNT REP:
  • Prepares billing and follow ups on claims in a timely manner.
  • Performs accurate and timely billing and account reviews ensuring that accurate information has been reviewed before sending to applicable payors or state agencies.
  • Conducts account review ensuring accurate billing information, enters and revises information as needed prior to claim being submitted.
  • Prepares adjustment bills, rebills, reprints claims and/or other source documents.
  • Processes failed claims in biller work file according to carrier specific requirements.
  • Coordinates with concurrent review precert nurse and/or admitting staff on precertification requirements.
  • Prepares daily productivity reports.
• CUSTOMER SERVICE - PATIENT CLAIM ISSUES:
  • Serves as liaison between patient, employer, and carrier in resolving claim issues.
  • Communicates with patient, employer and carrier regarding claim status.
  • Processes patient inquiry requests within 24 hours.
  • Assists with Customer Service coverage duties as need arises.
• KNOWLEDGE OF BUSINESS OFFICE DEPARTMENT GUIDELINES AND PROGRAMS:
  • Demonstrates knowledge of ever changing payer guidelines and regulations, programs and machines used.
  • Demonstrates mastery of computer programs and office machines used. Strong Performance includes mastery of the following skills, tasks and behaviors.
  • Creates and maintains via account notes, all correspondence, whether written or verbal, including discussion with carriers, patients or guarantors. Scans correspondence into the Chart Maxx system.
  • Submits Medicare Credit Balance Report quarterly, necessary to ensure that Phoebe Putney Memorial Hospital remains compliant with CMS rules and regulation.
  • Attends seminars and education relating to Medicare, Medicaid and Commercial.
  • Attends and participates in hospital and departmental staff meetings.
• DOCUMENTATION:
  • Documents and submits required information and data in a timely fashion.
  • Clearly and accurately documents designated processes, policies, products, service offerings, etc.
  • Ensures that documentation is tailored to expected readers / users.
  • Uses correct terminology.
  • Conforms to required style and format.
• Additional Duties
  • Adheres to the hospital and departmental attendance and punctuality guidelines.
  • Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
  • Performs other duties as required and completes all job functions as per departmental policies and procedures.
  • Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
  • Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
  • Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
  • For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
  • Wears protective clothing and equipment as appropriate.