Remote-Hospital Collections Representative

JOB SUMMARY

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. The 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. The 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 by 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 manner, interacting with insurance plans, patients, physicians, attorneys, and team members as needed.
• Basic computer skills to navigate system applications for 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.
• Maintain department daily productivity goals while meeting quality standards as determined by leadership.
• Identify and communicate issues such as system access, payor behavior, account workflow inconsistencies, or other insurance collection opportunities.
• Provide support for team members that may be absent or backlogged.

• Research each account using company patient accounting applications and internet resources. Conduct appropriate account activity on uncollected balances with contacting third party payors and/or patients via phone, e‑mail, or online. Problem solve issues and create resolution that brings in revenue, eliminating re‑work. Update plan IDs, adjust patient or payor demographic/insurance information, notate account in detail, identify payor issues and trends, and solve recoup issues.
  
  Request additional information from patients, medical records, and other needed documentation upon request from payors. Review contracts and identify billing or coding issues and request re‑bills, secondary billing, or corrected bills as needed. Take appropriate action to bring about account resolution timely or open a dispute record for further research and substantiation.
• Perform special projects and other duties as needed. Assist with special projects as assigned, document findings, and communicate results.
• Recognize potential delays and trends with payors such as corrective actions and respond to avoid A/R aging. Escalate payment delays/problem aged accounts 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.
• Ensure compliance with State and Federal Laws and 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.
• Clear and professional communication, strong oral and written skills.
• Strong interpersonal skills, above‑average analytical and critical thinking.
• Sound decision making ability.
• Full understanding of Commercial, Managed Care, Medicare and Medicaid collections, intermediate knowledge of Managed Care contracts, contract language, and Federal and State requirements for government payors.
• Familiarity with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB, hospital billing form requirements (UB04) and HCFA 1500 forms.
• Problem solving, prioritization, and follow‑through with assigned tasks.