What are the responsibilities and job description for the Patient Account Representative (1.0 FTE) position at St Peters Hospital?
- Performs pre-billing and billing functions to insure successful outcome of claim submission and payment.
- Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance.
- Collaborates with all Team Members within SPH to insure an accurate and timely billing.
- Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership
- Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals.
- Evaluate partial payments to determine if further reimbursement is valid
- Compose technical denial arguments for reconsideration, including both written and telephonically
- Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
- Escalate exhausted appeal efforts to Leadership
- Submits retro authorization to insurance within insurance carrier guidelines
- Researches and takes necessary action to follow up on unpaid claims using ATB’s and/or assigned work lists
- Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse
- Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess
- Use effective documentation standards that support a strong historical record of actions taken on the account
- Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application.
- Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation
- Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports.
- Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference.
- Response to all queries timely to insure Gold Standard Customer Service
- Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations
