Patient Account Representative

Description

Position Summary

The Patient Account Representative works under the supervision of the CFO and in conjunction with all other team members of the department and all other departments. Prepares out-patient accounts for rebilling, contacts responsible parties, via oral or written communication to collect accounts, handles phone calls concerning accounts. Communicates with patients/families who come into the office, completes paperwork on follow-ups and maintains an organized follow-up procedure to ensure timely payment and financial viability for the practice. Supports and follows through with the vision, mission, goals, and objectives of Family Healthcare of Hagerstown.

Responsibilities

As a member of the health center's integrated care team the Patient Account Representative will fulfill the following Key Functions and Responsibilities:

• Answer every phone call within three rings in a pleasant and courteous manner, identifying self and place of business.
• Returns all messages via paper, e-mail, or voice mail within one to two hours of receipt, with no calls not attempted to be returned by end of workday.
• Reviews in-coming mail to the finance department daily, rerouting to appropriate personnel when applicable, completing necessary activities within 1 working day.
• Responsible for maintaining printers, fax machines, and photo copier to accommodate workflow in the finance department, including changing paper, ribbons, cartridges, etc., when necessary. Call vendors when service is required.
• Utilizes the Practice Management System as a tickler file to track progress of payment on all insurance accounts.
• Reviews insurance reports and vouchers, determining course of action necessary to ensure correct application of write-offs per insurance and state regulations, timely re-submission, or re-submission with medical records, calling for authorizations, and other processing requirements with no more than 6 errors with re-submitting claims within 12-month period.
• Reviews and analyzes non-payment of identified accounts to decide when to refer accounts to designated collection agency.
• Analyzes accounts with complete self-pay balances and calls the patient for payments and/or sets up monthly budget payment plan. Assist patients with Financial Applications when applicable. Documents notes in the practice management system. Refers self-pay balances not meeting commitment to monthly budget plan to collection agency.
• Updates insurance information on accounts per department policy, investigating necessary insurances for required authorizations and/or referrals to determine if billing is appropriate, within 5 working days of receipt. Notifies patients, when necessary, of accounts billed incorrectly. Obtains required information and attachments for billing and corrects insurance changes in computer system with no complaints received within yearly review period.
• Keeps patients/families informed of any significant event that could affect their claim. Helps to educate patients and/or families about their insurance plan, coverage, and requirements. Assist the patient in making contact with their insurance company in an attempt to obtain or improve the coverage for a specific visit to get bills paid timely.
• Analyzes requests for additional documentation to verify appropriateness and ensures compliance with timely filing limits, identifying accounts for possible appeals and fair hearings, and referring them to appropriate personnel.
• Identifies patients needing financial assistance, makes referrals to the Outreach/Enrollment Counselor and/or designated personnel. In absence of Outreach/Enrollment Counselor, and in times of high demand helps patients complete financial assistance applications and completes processing for review and approval. Send Financial Assistance forms to patients to assist them with medical costs and payment of their bills.
• Submits all adjusted claims required to paper, on 1500/UB04 forms and/or rebills electronic claims via terminal within two (2) working days of receipt, with no more than two (2) reported variances per month. Submits all paper adjusted claims and/or electronic claims via terminal within the same day with no reported errors.
• Works with patients that have balances and offers payment plans as a payment option and follows up with patients that have not followed payment plan agreement. Patients are contacted on a monthly basis if payment is missing, and a practice management system account note is entered on collection activity.
• Consistently maintains Accounts Receivable at 75 days or less as shown by the monthly statistical billing reports produced each month. Consistently maintains Accounts Receivables at 65 days or less.
• Reviews Via-Track (clearinghouse) website for rejected claims twice per week and correct claims for resubmission.
• Demonstrates a working knowledge of Maryland Medical Assistance application process and of the Maryland Health Exchange. In the absence of the Outreach/Enrollment Counselor can answer questions about Maryland Medical Assistance and Exchange and refers clients to the Health Department of DSS if certified staff are not available onsite.
• Must be familiar with laws regulating collection practice including the "Fair Debt Collection Practices Act", "Fair Credit Reporting Act", Bankruptcy Laws, Bad Check Law, "Soldier's and Sailor's Civil Relief Act", Workers' Compensation Law, Lien Laws, Estate Laws, "Consumer Protection Credit Act" and Privacy Laws. Handles all accounts in accordance with regulations and acts with no reported violations.
• Assists walk-in patients when referred in reference to any billing questions, monthly statements, and insurance denials.
• Within the department policy on content, maintains consistent, complete documentation on all worked accounts within the Practice Management system, noting comments in account notes, with no more than 2 accounts missing adequate documentation per month.
• Demonstrates ability to utilize the office automation system to verify and determine insurance and departmental policies, ensuring correct application of account processing procedures. Notifies co/workers within the department of information updates via the e-mail system.
• Follows departmental policies with filing of referrals, new/old mail, telephone messages, etc., in the patient medical record so that information is in compliance with CHC and insurance regulations.
• Accepts other related duties as assigned in a positive manner.
• Demonstrates a positive safety attitude by keeping work area uncluttered and barrier free.
• Conducts one monthly site inspection for the CHC and completes appropriate inspection form on an annual basis. Independently identifies unsafe conditions and resolves them within scope of authority. As needed, reports on unsafe conditions to CFO.
• Responds to fire drills, disaster drills, and other emergencies 100% of the time.
• Communicates and provides services to patients in a manner that is age appropriate and respectful of a culturally diverse patient population.
• Restrictively endorses all checks made payable to the Center. No missed endorsements in prior year.
• Accurately completes deposit forms and deposit slips to reflect payment received, amount posted and ties to practice management payment report.
• ERAs are posted within two business days of being deposited in the bank.
• All payments received from third party insurance are posted within two days of receipt. 95% of payments received from third party insurance are posted within one day of receipt.
• Posts reason codes from remittance advice from payers when manually posting remittances.
• Notifies CFO of any reason codes from remittances that are not available for selection in Athena.
• Notifies CFO of any payments that are the same as the Center's fee schedule and or discrepancies such as codes not being paid or new denials. Research payment discrepancies and or denials with the insurer and presents recommendations to the CFO.
  
  

Knowledge, Skills, And Abilities

• Processes incoming and outgoing phone calls with responsible parties utilizing voice mail in accordance with department policy and applicable laws, answering questions concerning billing and collection, completing all paperwork on all initial and follow-up accounts to ensure amicable relations with the public and to expedite payment of monies due to the Walnut Street Family Practice.
• Reviews and bills accounts to all third-party payers (as appropriate) to ensure necessary cash flow.
• Maintains technical expertise in all areas of collection.
• Performs other related duties as assigned to keep the procedural flow of the department moving correctly.
• Is responsive to departmental needs to ensure efficient operation.
• Performs Payment Posting Procedures and Accounts Payable Matching/Filing
  
  

Generous benefits, including accrued paid time off, 7 paid holidays, 1 Anniversary Award (after first year). Eligible for health care, vision and dental benefits (employee, parent and child, employee and spouse, or family options). Company provided Life and AD&D Insurance. Company paid Long Term Disability, Employee Assistance Program, 403(b) plan with company match and additional voluntary benefits including cancer, hospital, accident coverage, and more.

Requirements

POSITION QUALIFICATIONS

Education: Graduate from high school with commercial courses or the equivalent required. Medical/Secretarial program preferred. 1-2 years' experience as a patient account representative or the equivalent required.

Experience: Good typing and computer skills required. Basic filing procedures required. Excellent communications skills required. Excellent customer relations skills required.

Must be able to prioritize and organize work, analyze, and make decisions with a minimum of supervisor input. Works independently.

Minimum of one year of previous experience with hospital/medical office billing/collection procedures, or medical insurance company claims processing, with knowledge of types of medical insurance (HMO, managed care, fee for service) required.

Excellent communication skills and ability to manage confidential patient information. CPR certification is preferred.

PHYSICAL AND MENTAL EFFORT

Physical: Minimum physical effort required. Intermittent sitting with freedom of movement. Occasional walking, bending, lifting, pulling and reaching. Normal vision and hearing required.

Mental: Frequent periods of concentration and attention to details with frequent opportunity for diversification of tasks. Frequent

interruptions. Sensory requirements include the ability to articulate and comprehend the spoken English language, in addition to being able to read and write the English language.

ENVIRONMENTAL AND WORKING CONDITIONS

Work is performed in a modern well-equipped environment. Interfaces with fellow employees on a daily basis. Uses office equipment daily, multi-line telephone, fax machine, copier, shredder, and computer.