Patient Relations Representative IV

Overview

Patient Relations Representative IV role at Craven County Government. Primary purpose of this position is to validate patient account information via the patient encounter form and clinical records to ensure correct billing for services rendered and post to A/R ledger.

• Post daily charges from eSuperbill or encounter forms by 5:00pm.
• Verify completeness of information such as charge codes, diagnosis and modifiers at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue; determine correct method of resolving discrepancies by coordinating with appropriate staff.
• Review patient demographic information at charge entry to ensure accuracy and provide feedback to front office staff regarding patient registration.
• Review insurance details, family household income, current charges and/or outstanding balances and verify dates of services.
• Review all claims for accuracy prior to submission.
• Schedule follow-up appointments.
• Ensure all encounter forms are received by the Billing Office for charge entry.
• Demonstrate understanding of patient confidentiality to protect patients and the organization.
• Follow policies and procedures that contribute to the efficiency of the billing office.
• Keep supervisor informed of matters regarding charge entry.
• Respond to inquiries from clinical staff, social workers, and clerical staff regarding billing and coding information; provide income verification and insurance documentation to clinical staff as requested.
• Collect and post payments from current and outstanding patient debt; set up payment plans as needed and use appropriate processes including the County’s NC Debt Set-Off program.
• Notify the in-house Debt Set-Off coordinator of 60-day delinquent accounts for submission to the IRS.
• Stay informed of updated fee scales and provider updates to maximize claim collection.
• Verify encounters against the daily schedule and track missing encounters or returns for missing information.
• Balance daily deposits to the cash drawer; prepare a deposit slip for the Accounting section.
• Contact insurance companies for unpaid claims and patient verification.
• Ensure all prepayments are applied to charges by 5:00pm.
• Review and update pending insurances for eligibility; if eligibility cannot be determined, services older than 60 days may be considered no coverage and transferred to patient responsibility.
• Mail Company Billing invoices monthly by the first of each month.
• Provide backup to other Patient Relations Representatives as needed.
• Prepare letters as needed; ensure proofreading for spelling, punctuation and grammar; correspondence with other agencies, insurance carriers, and patients is approved by the Administrative Officer.
• Other duties as assigned by supervisor(s) and/or management.
• In the event of a disaster, may be required to assist as needed.

Graduation from high school and at least two years of office assistant/secretarial experience, or an equivalent combination of training and experience.

Requires a comprehensive understanding of accounts receivable management in a healthcare setting. Strong customer service, organizational and communication skills are essential. Strong working knowledge of CPT, ICD-10, HCPCS, modifiers, coding and documentation guidelines. Also requires general computer skills, typing skills and a working knowledge of Medicaid and Medicare Compliance, OSHA and HIPAA.

• Entry level

• Full-time

• Health Care Provider

• Government Administration