Patient Accounts Representative

Description

Shift: 7:30a-4:30p Monday-Thursday, 7:30a-1p Friday

Job Summary: Responsible for the insurance billing process between the hospital and insurance companies, federal agencies and third party payers. Audits patient accounts to ensure procedure, charges and coding accuracy. Collects payments from commercial insurance companies, state and federal agencies. Participates in performance improvement and continuous quality improvement (QI) activities.

Job Duties and Responsibilities:

• Coordinates the payment process and collects payments from insurance companies, federal and/or state agencies and/or third party payers by utilizing billing system to complete appropriate forms and submission
• of claims to proper agencies/insurance companies.
• Maintains a professional, working relationship with the insurance companies, government agencies and/or third party payers.
• Works independently to resolve account problems and timely follow-up.
• Resolves overpayments and communicates with Business Office Director on refunds.
• Able to assist with receipt process and adjusts patients’ bills to reflect credits, debits and balances.
• Understands pre-certification and referral process as it relates to assigned insurance.
• Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers and patients on patient’s accounts.
• Stays informed of changes in the insurance industry.
• Consults with other hospital departments to obtain, verify billing information.
• Always accepts other assignments as needed.
• Demonstrates the ability to be flexible, organized and function well in stressful situations.
• Communicates clearly and accurately with the Business office Director and other staff members.
• Performs limited account audit using information available to verify accuracy in charges and coding.
• Maintains a good working relationship within the department and with other departments of the hospital.
• Coordinates patients/insurance companies to resolve unpaid insurance claims.
• Interacts with patients/families in a professional manner. Provides explanations regarding statements and insurance procedure.
• Treats patients/families with respect; ensures confidentiality of protected patient information.
• Utilizes voice mail as necessary ensuring quality customer communication service when out of the office.
• Responsible for preparation of daily deposit and maintaining correct balance in cash drawer.
• Responsible for payment transactions, including downloading and balancing electronic remittance advices and providing customer receipts.
• Prepares and posts adjustments, contractuals and rejections.
• Responsible for entering all transactions into the computer system accurately and in a timely manner.
• Responsible for utilizing the safe for large bills, and large amounts of money from the cash drawer.
• Provides petty cash to various departments of the hospital, and collects daily revenues from these departments; provides receipts of all transactions.
• Responsible for providing change to patients, visitors and employees.
• Receipts payments received in the Admitting Department and/or directly from the patient/family.
• Assists customers who present at business office counter.
• Responsible for security measures, placing cash drawer in safe upon closing.
• Manages and operates all equipment safely and correctly.
• Enters accurate documentation on patient account when applicable.

Requirements

Professional Requirements:

• Adheres to dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Reports to work on time and as scheduled; completes work within designated time frame.
• Wears identification while on duty, uses computerized time system correctly.
• Completes hospital in-services as required.
• Utilizes access to internet web-based insurance resources for education, eligibility, follow up and billing as applicable.
• Maintains and ensures patient confidentiality at all times.
• Performs department in-services.
• Works at maintaining a good rapport and a cooperative working relationship with physicians, departments and staff.
• Represents the organization in a positive and professional manner.
• Attends committee, CQI and management meetings, as appropriate.
• Ensures compliance with policies and procedures regarding department operations, fire, safety and infection control.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, vision and core values of the hospital.
• Demonstrates knowledge and/or location of Safety/Emergency Preparedness Manual, location of disaster packets, personal protective equipment and responsibilities during all Codes.
• Adherence with compliance of William Newton Hospital’s policies. Demonstrates familiarity with employee handbook.

Regulatory Requirements:

• High school graduate or equivalent.
• Thorough understanding of different insurance plans, government agencies, Medicare and Medicaid as relates to assigned insurance responsibilities preferred.
• Previous billing experience preferred.