ACCOUNT REP I

Position:   Account Rep I

Department:  Business Office

Reports To:  Manager – Business Office

Direct Reports:  None    

FLSA Classification:  Non-Exempt

Position Summary

The Account Rep is responsible for providing outstanding customer service while performing a variety of clerical duties related to receiving, verifying, processing and recording insurance and patient payments. Will also perform business office secretarial duties including answering patient inquires and questions regarding patient payments.

General Duties, Tasks and Responsibilities

• Ensures insurance claims are billed through the billing system after appropriately coded; reviews billing system errors and fixes prior to sending claims; sets up secondary claims to bill or notify appropriate biller for billing.
• Determines appropriate payment plan option(s) requested by patient based on income level; demonstrates good judgment on patient's reported income level in determining if more documentation is necessary and collects required documentation as needed.
• Accurately posts insurance payments; bills self-pay balances; sets up self-pay balance to go to agency per policy if no payment plan is set up; reviews and resolves billing conflicts with agency.
• Documents pertinent billing notes and patient communications in hospital billing systems to reflect accurate account history; explains receipting and insurance billing processes and reads account details to patients.
• Processes status claims for follow up before EOB is received; reviews AR for follow up on accounts; follows up on insurance in a timely manner to meet or exceed department policy standards; reports backlogs immediately to supervisor so that assistance can be utilized to relieve backlog.
• Monitors and updates hospital/billing systems and forms as needed for accurate billing; utilizes available resources to maintain billing compliance knowledge.
• Reviews and understands financial assistance program; refers patients to other assistance agencies as appropriate; evaluates likelihood of payment from other payers.
• Reviews and understands DRGs, HCPCS, CPT and ICD codes and their purpose on the billing forms and who is authorized to make changes to those codes; works with Home Health to resolve CPT/diagnosis code conflicts; informs supervisor as appropriate.
• Reviews and understands financial assistance program; refers patients to other assistance agencies as appropriate;   
• Evaluates likelihood of payment from other payers.
• Determines appropriate payment plan options requested by patient based on income level; demonstrates good judgment on patient's reported income level in determining if more documentation is necessary and collects required documentation as needed.
• Prepares files, tracks and follows up on financial assistance packets, liens, estates and collection agencies in a timely manner.
• Submits self-pay and collection agency accounts timely; processes returned reports and documents (i.e. collection agency reports and bad checks).
• Documents pertinent billing notes and patient communications in hospital billing systems to reflect accurate account history; explains receipting and insurance billing processes and reads account details to patients.
• Prepares billing reports requested by supervisor and supports audit requests for documents.
• Ensures timely and accurate data exchanges between EMR and outsourced agencies.
• Complies with all established safety procedures to ensure a safe environment for patients, visitors and staff.
• Participates in performance improvement activities.
• Performs other duties as assigned.

Education Requirements

• High School diploma / Equivalent Required
• Associate's Degree in a related field Preferred

Experience Requirements

• Office / Clerical setting minimum 1 year Preferred
• Healthcare Insurance / Billing minimum 1 year Preferred

Computer Skills

Additional Skills

• Strong interpersonal, organizational and time management skills
• Excellent written and verbal communication skills, be professional, polished and articulate well
• Knowledge of criteria for Medicare, Medicaid, HMO and private insurance