Patient Relations Representative IV

Patient Relations Representative IV (10775)

Primary purpose of this position is to validate patient account information via the patient encounter form and various clinical records to ensure correct billing for services rendered and post to A/R ledger.

Responsible for posting daily charges from eSuperbill or encounter forms by 5:00pm.

• Verify completeness of all information such as charge codes, diagnosis and modifiers provided by clinical staff at the time of charge entry to ensure accuracy, timely payments, and maximize revenue. Determine correct method of resolving discrepancies by tasking and following up with appropriate staff to obtain complete information.
• Review patient demographic information at the time of 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 an understanding of patient confidentiality to protect the patient 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 of the patient. Provide income verification and insurance documentation to clinical staff, as requested, to support referrals and/or orders.
• Collect and post payments from both current and outstanding patient debt to individual accounts. Set up payment plans for accounts not paid in full; other methods may be through the normal billing process or by utilizing 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 as published by the Health Department and other agencies, along with private provider updates for filing claims. This helps the Health Department achieve maximum collection.
• Verify encounters received against the daily schedule and track missing encounters as well as encounters returned to the clinic for missing information.
• Balance daily deposits to the cash drawer via the day sheet. Prepare a deposit slip and turn it in to the accounting section by the Accounting Tech III.
• 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 are considered to have no coverage and then transferred to the patient’s responsibility.
• Mail Company Billing invoices monthly by the first of every month.
• Turn on television in the lobby by 8:00am and turn it off by 5:00pm.
• Provide backup to other Patient Relations Representative positions within the unit.
• Construct letters as the need arises. The Administrative Officer will review all correspondence before documents are released outside the agency. Correspondence pertains to letters to other agencies, insurance carriers, and health‑department patients. All documentation should be proofread for spelling, punctuation, and grammar.
• Perform other duties as assigned by supervisor(s) and/or management.
• Assist as needed in the event of a disaster.

Graduation from high school and demonstrated possession of knowledge, skills, and abilities gained through at least two years of office assistant/secretarial experience; or an equivalent combination of training and experience.

• Comprehensive understanding of accounts receivable management in a healthcare setting.
• Strong customer service, organizational, and communication skills.
• Working knowledge of CPT, ICD‑10, HCPCS, modifiers, coding, and documentation guidelines.
• General computer skills, typing skills, and knowledge of Medicaid and Medicare compliance, OSHA, and HIPAA.

• Seniority level:
  Entry level
• Employment type:
  
  Full-time
• Job function:
  Health Care Provider
• Industries:
  Government Administration