Position Summary:Under the leadership of the Director, Patient Financial Services, thePatient Account Representative is an active member of the Patient Accounting team that delivers professional accounting services and support that is consistent with the strategic vision, goals, philosophy and direction of Patient Accounting and CRHS. The Patient Account Representative works with an assigned group of accounts to ensure the accuracy and completeness of billing amounts and patient information. The representative processes electronic claim submissions for payment within established timeframes and tracks payments as necessary. This position works with appropriate parties to remedy past due accounts and processes and deposits payments received. Basic Qualifications:
Requires a high school diploma with an emphasis in Office Occupations or a GED state certificate. An Associate's degree in Accounting is preferred.
Requires one to two years of work-related experience in accounting or bookkeeping or any equivalent combination of education, training and experience. Experience in healthcare-related accounting or bookkeeping is preferred.
- Licensure, Registrations & Certifications:
Billing Specialist Certification or Patient Account Representative certification (CPAR) is preferred. Essential Job Responsibilities:
- Maintains and controls an assigned section of patient accounts.
- Reviews files daily and checks final amounts for accuracy and completeness, verifies and edits patient demographic and insurance information prior to claims submission.
- Ensures the accuracy of accounting for all accounts.
- Records late charges on patient accounts for appropriate logs.
- Enters require UB92 and/or 1500 physical billing, or other pertinent information not in the system for electronic transmission of insurance claims.
- Prepares and submits claims to carriers and intermediaries within 24 hours after all information is available for billing.
- Monitors account for the trace follow-up to the insurance company and/or employers when necessary.
- Processes and responds to correspondence from patients, insurance companies or third parties regarding insurance benefits, unpaid claims, and account balances.
- Contact patient account guarantors by telephone or mail to secure contracts or collection of payments.
- Assists with the process of filing liens, garnishments or initiating other legal action to remedy unpaid accounts.
- Review accounts records and ensures that collection letters are sent and debtors are contacted according to established hospital policy.
- Monitors collect agency reports and remittances for accuracy.
- Follows established procedures for collecting NFS check returns.
- Resolves payment problems with patients and third party payers.
- Reviews account status for referral to outside collection agencies prior to write off.
- Deposits daily receipts with Business Office Accounts Receivable staff and ensures cash funds are reconciled.
- Ensures effective billing for accounts queued in other web-based software (eSolutions, etc.) and other billing solutions (AllScripts, etc.) or other various billing applications.
- Serves as a back-up for the Hospital Financial Counselor/Business Office Cashier.
- Prepare reports or statistics as required.
- Ensures that accounting entries are made according to generally accepted accounting principles and CRHS policy.
- Complies with all CRHS privacy policies and procedures including those implementing the HIPAA Privacy rule.
- Attends in-service training, education programs and meetings as required or directed.
- Adheres to established CRHS and departmental policies, procedures and objectives for quality assurance, safety, environmental, and infection control.
- Performs other related job duties as assigned.
Standards of Performance:
- Works with an assigned group of accounts to ensure the accuracy and completeness of billing amounts and patient information.
- Processes electronic claim submissions for payment within established timeframes and tracks payment as necessary.
- Works with appropriate parties to remedy past due accounts and monitors collection agency reports and remittances for accuracy.
- Participate in education as required through mandatory department in-service and continuing education as measured by education and attendance records and maintenance of professional certifications.
- Demonstrates adherence to CRHS Standards of Behavior as measured by co-workers and supervisor observations.
- Demonstrates reliability as measured by compliance with CRHS time and attendance policies.
- Demonstrates professional conduct by maintaining strict confidentiality and compliance with HIPAA standards as measured by valid complaints given to the Supervisor or Director.