Patient Account Representative

Summary

Essential Duties and Responsibilities

• Examines denied and underpaid claims to determine reasons for discrepancies.
• Communicates via phone calls and web-portals, directly with payers to follow up on outstanding claims, resolves payment variances, and achieves timely reimbursement.
• Provides payers with specific reasons for suspected underpayments and reviews denial reasons given by payers. Documents patient account (HAR) with status and expected payment amounts.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing Accounts Receivables (A/R).
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies.
• Keeps current using payer bulletins, coding and billing training and manuals.
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information. Notifies PFS Manager of changes to update other TFH Departments.
• Thoroughly documents all interactions with payers.
• Handles all payer-specific communications, including telephone and email, from payers and departments within the business office.
• Participates in quality improvement efforts on an ongoing basis. Strives to exceed productivity goals as established based on industry standards as approved quarterly by the CFO.
• Demonstrates initiative and resourcefulness by gathering information and examples about issues and helping to document recommendations for system fixes.
• Communicates trends and issues to management and helps to monitor and validate fixes.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Performs other duties as assigned.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities

• No supervisory responsibilities.
• Minimum Education/Experience No educational requirement and 2-3 years relevant experience
• Required Licenses/Certifications None

Other Experience/Qualifications

• Required:
• Minimum of two years recent billing and follow-up experience in hospital and/or physician clinical areas.
• Preferred:
• Prior experience in Medicare or Medi-Cal (Medicaid) billing, EPIC Hospital Billing and/or Physician Billing.
• Knowledge in Critical Access and RHC billing.