Patient Account Representative - Full-Time - Days
Copley Health Systems Inc. | Morrisville, VT
The Patient Account Representative functions in a team environment to appropriately resolve patient accounts. The responsibilities encompass all financial aspects of the patient encounter from initial billing through final resolution of the account, while maintaining excellent customer service. The Representative specializing in insurance billing & collections is responsible for accurate and timely billing and collections of insurance claims, conducting all activities in compliance with all applicable State and Federal laws, regulations, and policies governing the provision of health care.
- ACCOUNT MANAGEMENT: Extends payment arrangement offers to guarantors in accordance with department policies and procedures.
- INSURANCE BILLING: Submits coded, complete, timely, and clean claims to assigned carrier(s), either electronically or on paper, on a daily basis, with accuracy and in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier. This includes appropriately working claim edits and timely resolution of claim quality issues and follow-up on missing information.
- INSURANCE BILLING: Reviews late charges on a daily basis and takes appropriate action to submit corrected claims, in accordance with department policies and procedures.
- INSURANCE BILLING: Reconciles claim submission index in CPSI (EBOS) to ensure that electronic claims submitted are cleared thru the clearinghouse and accepted by the carrier. Follows-up timely on outstanding claim files.
- INSURANCE BILLING: Takes appropriate and timely action on all correspondence related to assigned carrier(s) in accordance with the policies and procedures of the PFS department and the specific policies and billing guidelines of the insurance carrier.
- COLLECTIONS: Reviews posted remittance advices from assigned insurance carrier(s) within the timeframe established by department policies and procedures, appropriately following up on and resolving any rejections or other non-payments to ensure accurate posting of balances for reimbursement, deductible, co-pay, co-ins, contractual adjustment, non-covered charges, rejected claims, and any balance-billing to the patient or guarantor as appropriate. Communicates appropriately with others within the organization to keep them informed of any non-payment or denial applicable to their area of service or responsibility.
- COLLECTIONS: Follows up on outstanding insurance claims on a daily basis using the Billed but Unpaid report, as well as any priority listing of unpaid claims as assigned by the Billing & Collections Manager and or Director of Revenue Cycle.
- CUSTOMER SERVICE: Responds to internal and external account inquiries in a timely manner and with the utmost professionalism and courtesy. This includes actively participating in the main line phone queue throughout the day.
- OTHER RESPONSIBILITIES: Timely management of documentation in the office in accordance with department policies and procedures (ie. filing, scanning, etc.), and in compliance with privacy requirements of HIPAA, to promote an efficient work flow, ready access to necessary documents by all of the appropriate parties, and the protection of private health information.
- COLLECTIONS: Reviews credit balance accounts at least weekly to identify potential overpayments and submit timely requests for recoupment or refund, in accordance with the requirements of the assigned carrier(s) and department policies and procedures. Prepares credit balance reporting timely, as required by the assigned carrier if applicable.
- COLLECTIONS: Works collaboratively with others in the organization to appeal non-payments or denials of claims for services, as appropriate, and in accordance with the requirements of the assigned carrier(s). Communicates outcomes of appeals to the involved parties.
- ACCOUNT MANAGEMENT: Manages insurance claim lines, collect codes, patient profile information, and electronic files in patient accounts in accordance with the policies and procedures of the PFS department and the Patient Access department.
- ACCOUNT MANAGEMENT: Enters appropriate, succinct, and professional notes in patient accounts in a timely manner for ALL communications with, or regarding, patients, guarantors, or insurance carriers.
- OTHER RESPONSIBILITIES: Perform all job duties with the utmost integrity and in compliance with the requirements of the assigned insurance carrier(s)'s policies and all applicable State and Federal laws, regulations, and policies governing the provision of health care. This includes maintaining a current knowledge of applicable laws, regulations, and policies, as well as communicating any known or suspected compliance concerns to the Billing & Collections Manager, Director of Revenue Cycle, and or the Compliance Officer.
- OTHER RESPONSIBILITIES: Keeps the Billing & Collections Manager and or Director of Revenue Cycle informed of issues encountered in common billing edits, rejections or other non-payments, patient complaints, and any other major issues impacting customer service, cash flow, productivity, revenue integrity, or compliance.
- OTHER RESPONSIBILITIES: Other duties as necessary upon the direction of the Billing & Collections Manager and or Director of Revenue Cycle.
- INSURANCE BILLING: Keeps self informed of billing policies and requirements of assigned insurance carrier(s) by regularly monitoring list-servs, carrier websites, maintaining open lines of communication with provider representatives, researching problem claims, and other means of staying informed that the assigned carrier(s) makes available.
- High School Diploma or equivalent.
- Medical Terminology Course desired.
- Desired h ealth care insurance billing experience, or experience in a hospital admitting, registration, business office, or coding function.