Remote- Hospital Patient Account Collections Representative

JOB SUMMARY

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities.

Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

• Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
• Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions.
• Access payer websites and discern pertinent data to resolve accounts.
• Utilize all available job aids provided for appropriateness in Patient Accounting processes.
• Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account.
• Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
• Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities.
• Provide support for team members that may be absent or backlogged.

• Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues.
  
  Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/problem aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Intermediate skill in Microsoft Office (Word, Excel).
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently.
• Ability to communicate in a clear and professional manner.
• Must have good oral and written skills.
• Strong interpersonal skills.
• Above average analytical and critical thinking skills.
• Ability to make sound decisions.
• Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors.
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

• High School diploma or equivalent. Some college coursework in business administration or accounting preferred.
• 1-4 years medical claims and/or hospital collections experience.
• Minimum typing requirement of 45 wpm.

• Office/Team Work Environment.
• Ability to sit and work at a computer terminal for extended periods of time.

• Call Center…