Patient Account Representative

J  o  b    D  e  s  c  r  i  p  t  i  o  n

          Joy                         Care                      Competence                    Respect

Position Summary

The Patient Account Representative is responsible for resolving outstanding unpaid, unprocessed and/or denied medical claims to third-party payers. This role frequently interfaces with insurance companies.

High school diploma or equivalent is preferred.

2 years of experience processing medical insurance claims is preferred.

N/A

Demonstrated ability to maintain confidential information.

Demonstrates a high level of accuracy.

Friendly and service oriented; articulate and responsive to customers.

Demonstrated time management and priority setting skills; performs work independently with minimal supervision.

Ability to learn and use various financial applications (e.g., Claimsource, Vitalware and On Base) and payer websites to check claim status, eligibility and authorization status.

Knowledge of payer reimbursement methodologies and ability to understand and resolve variances.

Ability to understand the UB04 and HCFA 1500 claim forms and coding requirements for each form.

Reviews, researches and resolves the accounts being worked.

Verifies accuracy of billing data and corrects errors; prepares and resubmits clean claims to multiple contracted insurance companies and government payers.

Performs workflows in a productive and effective manner as defined by policies and procedures.

Resolves payer edits and rejections within defined time frames.

Provides appropriate and detailed documentation of research and outcomes on accounts.

Accesses web-based applications and internet for claims status, eligibility of services and reconsiderations.

Processes claims-related correspondence (i.e., rejections, denials, appeals, payer requests).

Maintains work queues to ensure timely submission and follow-up of claims.

Utilizes accounts receivable (AR) reports and explanation of benefits (EOBs) to identify and resolve outstanding third-party claims.

Works with insurance companies to resolve contractual issues.

Notifies supervisor or management team of payer trends and issues that may affect workflow and management of claims.

Possess the information, skill, and understanding of the work to be performed.  Actively participates in continuing education opportunities and maintains certifications, licensure as appropriate.

Abides by all safety requirements including demonstrating proper hand hygiene and wearing of Personal Protective Equipment (PPE), if applicable. 

Complies with all standards, policies and procedures including dress code, attendance and punctuality.  Attends required in-services and meetings and completes all mandatory competencies by deadline. Commits to keeping all patient, student or colleague information confidential and maintains ongoing communication and collaboration with team members. 

The purpose of this job description is to provide a summary of the major responsibilities performed by colleagues in this position. Colleagues may be requested to perform tasks other than those specifically presented in this job description.  Variances in job duties performed may exist between facilities, and colleagues may perform other related duties as assigned to meet the needs of the organization.

PHYSICAL, MENTAL AND ENVIRONMENTAL REQUIREMENTS

Physical, Mental and Environmental Requirements Category:

Administrative

Standing

X

Walking

X

Sitting

X

Lifting

X

20 lbs.

Carrying

X

20 lbs.

Pushing

X

20 lbs.

Pulling

X

20 lbs.

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Use of Hands/Dexterity

X

Talking

X

Hearing

X

Eye/Hand/Foot Coordination

X

Extreme Cold

X

Extreme Heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Other