Patient Account Representative

Summary:

The Staff Pad is honored to partner with a non-profit healthcare
system in Helena, Montana with superior care and a hometown commitment to be
the gold standard for health care in Montana. We are in search of a Patient
Account Representative to join their team.

Responsibilities

1. Performs
   pre-billing and billing functions to insure successful outcome of claim
   submission and payment.
   
2. Follows
   all billing and regulatory guidelines, per insurance carrier, to insure
   facility compliance.
   
3. Collaborates
   with all Team Members within SPH to insure an accurate and timely
   billing. 
   
4. Collect
   outstanding insurance company balances as quickly as possible by applying
   collection best practices as defined by Leadership
   
5. Utilize
   various A/R reports to target aged balances for collection to meet and
   maintain performance goals.
   
6. Evaluate
   partial payments to determine if further reimbursement is valid
   
7. Compose
   technical denial arguments for reconsideration, including both written and
   telephonically
   
8. Overcome
   objections that prevent payment of the claim and gain commitment for
   payment through concise and effective appeal argument
   
9. Escalate
   exhausted appeal efforts to Leadership
   
10. Submits
    retro authorization to insurance within insurance carrier guidelines
    
11. Researches
    and takes necessary action to follow up on unpaid claims using ATB’s
    and/or assigned work lists
    
12. Works
    pending claims in the CMS Direct Data Entry software (DDE) and SPH claims
    Clearinghouse
    
13. Analyses
    insurance payments received to verify account was paid per contract, if
    not, contacts insurance to reprocess 
    
14. Use
    effective documentation standards that support a strong historical record
    of actions taken on the account
    
15. Reviews
    and follows through on credit balances through take back initiation,
    refund initiation, and/or payment re-application.
    
16. Reports
    Medicare credits quarterly to Medicare on appropriate form and supplies
    all supporting documentation
    
17. Logs
    and adjusts all appropriate Medicare bad debt cancels so they can be
    reported on year-end financial reports.
    
18. Works
    patient and insurance correspondence timely. Respond and document in
    account and scan documents into patient account for future reference.
    
19. Response
    to all queries timely to insure Gold Standard Customer Service 
    
20.  Role
    requires adherence to quality assurance guidelines as well as established
    productivity standards to support the work unit’s performance expectations
    

Qualifications

KNOWLEDGE/EXPERIENCE: 

• Previous
  work experience in insurance billing regulations and understanding
  insurance contracts preferred but not mandatory
  
• Knowledge
  of state and federal regulations as they relate to the billing process
  preferred but not mandatory 
  
• Proficient
  keyboard/ 10 key skills and working knowledge of computers required. 
  
• Good
  verbal and written communication skills. 
  
• Strong
  data entry, ten key skills and working knowledge of computer
  required. 
  
• Exceptional
  customer service and interpersonal communication skills.
  
• Proficient
  in examining documents for accuracy and completeness.
  
• Ability
  to multitask and manage time effectively.
  
• Ability
  to grasp, retain, and apply new regulations
  
• Mathematical,
  organization skill and business correspondence skills. 
  
• Basic
  knowledge in downloading/creating spreadsheets in Microsoft Excel
  

EDUCATION:    High School diploma or GED
required. Completes Patient Financial Services I training within first 5 month