Job Description

POSITION SUMMARY

The Patient Account Representative is responsible for submittal of electronic and manual billings, account statements, and for follow-up with third-party payers and patients for outstanding balances, including financial counseling. This position is also responsible for the preparation and maintenance of insurance and Treatment Authorization Request logs daily.

QUALIFICATIONS

Education :  High school graduate or equivalent.

Experience: A minimum of two (3) years’ experience in insurance billing and/or patient accounting is required. Any combination of education, training, or experience in a hospital business office is preferred.  Experience with Medicare, Medi-Cal, and all other major payors, computers, and business software programs required.  

Additional Requirements: May be required to work occasional overtime and flexible hours.

MANDATORY SKILLS AND QUALIFICATIONS

1. Proven analytical and problem-solving skills.
2. Exceptional verbal and written communication skills.
3. High time management and organizational skills.
4. Minimum of 3 years’ experience in a patient accounting or medical insurance environment.

PRIMARY RESPONSIBILITIES

1. Prepare all accounts for billing and ensure account billing productivity standards are met:
2. Prepare and submit insurance billings to primary and secondary payers.
3. Prepare and submit all Treatment Authorization Request for Medi-Cal/County pay.
4. Contact all payers at a 30-day interval after billing to assure that bills have been received and are being processed.
5. Contact all payers on insurance billings a minimum of twice every 30 days for payment status.
6. Correspondence is answered within 72 hours of receipt.
7. Maintain a current tickler and/or aging system for prompt follow-up on billing cycles.
8. Document contacts on a productivity log.
9. Ensure account activity is current and accurately documented:
10. Update financial class of accounts if there is secondary insurance to be billed.
11. Complete a denial notification notice when payments are denied and ensure documentation on the folder is completed.
12. Maintain an up-to-date Midas when receiving denial. Provide chart and denial documentation to U/R department for review.
13. Prepare billing reports as required by the department.
14. Review for accuracy all records and uniform billings (UBS) for third-party payers.

3. Provide follow-up on progress of appeals, and prepare documentation as

required.

1. Maintain Medicare and Medicaid statistical logs and databases.
2. Prepare departmental billing and statistical report as required
3. Adhere to facility, department, corporate, personnel and standard policies and procedures.
4. Attend all mandatory facility in-services and staff development activities as scheduled.
5. Adhere to facility standards concerning conduct, dress, attendance and punctuality.
6. Support facility-wide quality/improvement goals and objectives.
7. Maintain confidentiality of facility employees and patient information.
8. Discuss payment arrangements with patients for outstanding patient balances.
9. Establish payment arrangements with the patient and document appropriately in the practice management system.

Note:  The essential job functions of this position are not limited to the duties listed above.

KNOWLEDGE, SKILLS, AND ABILITY

THIS SECTION DESCRIBES WHAT KNOWLEDGE, SKILLS AND ABILITY AN EMPLOYEE IN THIS POSITION SHOULD CURRENTLY POSSESS.  THIS LIST MAY NOT BE COMPLETE FOR ALL KNOWLEDGE, SKILLS AND ABILITY REQUIRED FOR THIS POSITION .

1. Knowledge of all code procedures.
2. Knowledge of computers and business software.
3. Knowledge of insurance billing.
4. Skill in telephone etiquette and paging procedures.
5. Effective oral and written communication skills.
6. Ability to adhere to safety policies and procedures.
7. Ability to use good judgment and to maintain confidentiality of information.
8. Ability to work as a team player.
9. Ability to demonstrate tact, resourcefulness, patience and dedication.
10. Ability to accept direction and adhere to policies and procedures.
11. 1. Ability to recognize the importance of adapting to the various patient age groups (adolescent, adult and geriatric).
    2. Ability to work in a fast-paced environment.
    3. Ability to react calmly and effectively in emergency situations.
    4. Ability to meet corporate deadlines.

    PHYSICAL, MENTAL, AND SPECIAL DEMANDS

    THIS SECTION DESCRIBES HOW AN EMPLOYEE IN THIS POSITION CURRENTLY PERFORMS THE FUNCTIONS OF THIS POSITION.  MODIFICATIONS TO THE MANNER IN WHICH THIS JOB MAY BE PERFORMED WILL BE REVIEWED ON A CASE-BY-CASE BASIS.

    1. Ability to work a 40-hour week.
    2. Ability to sit for long periods, up to 8 hours.
    3. Ability to use both hands in fine and gross manipulation of small tools (copier, computer, telephone, typewriter, calculator, safe, facsimile machine).
    4. Ability to push and pull up to 10 lbs. (File cabinet drawers, computer paper boxes).
    5. Ability to see well enough to read handwritten and typewritten material.
    6. Ability to lift and carry up to 25 pounds to move transfer file boxes, data processing paper, and newly admitted patients’ belongings, as required.
    7. Ability to retrieve files from bottom shelves and drawers and to move boxes of paper and forms to the computer printer.
    8. Ability to reach, turn and twist above and below the waist daily to retrieve files from top shelves to obtain office supplies from upper shelves in supply closet.
    9. Ability to hear and speak well enough to answer and communicate on the hospital switchboard.
    10. Ability to spend 90% working time in environment of continuous low voices and office machine noise typical for business office atmosphere.
    11. Ability to handle a variety of repetitive tasks.

    MACHINES, TOOLS, EQUIPMENT, AND OTHER WORK AIDES:

    THIS SECTION DESCRIBES THOSE MACHINES, TOOLS, EQUIPMENT, AND OTHER WORK AIDES AN EMPLOYEE IN THIS POSITION MUST BE ABLE TO USE.

    1. Telephone, switchboard and paging systems.
    2. Copy machine.
    3. Computer and various software packages.
    4. Calculator/10-Key.
    5. Facsimile machine.
    6. Postage machine.
    7. Policies, procedures, plans and program manuals.

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