<p>JOB SUMMARY: Medical billing experience is required. The patient account representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The patient account representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate.</p> <p>QUALIFICATIONS:</p> <p>JOB SPECIFIC CORE COMPETENCIES:</p> <ul> <li>Accurately bills and collects insurance payments. </li><li>Works with patients and third party payors to obtain payment on delinquent accounts according to legal and proper collection techniques as well as maintain A/R days outstanding within established HPN guidelines. </li></ul> <p>ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:</p> <p>The following list describes the essential duties of this role. Individuals in this role may not perform all of these duties, or may perform additional, related duties not listed here.</p> <ul> <li>Performs daily billing processes including but are not limited to pre-billing reports/workqueues, claim corrections, and Medicare FISS system claim corrections,. </li><li>Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current. </li><li>Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others. </li><li>Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that would impacts Government and NonGovernment billing and follow-up. </li><li>Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans. </li><li>Informs leadership of changes in payer requirements. </li><li>Exercises independent judgment to report repetitive rejections so that corrective actions can occur. </li><li>Treats patients and their families along with internal customers with respect and dignity. </li><li>Ensures confidentiality of patient records. </li><li>Responds to customer concerns in a timely and professional manner. </li><li>Meets productivity standards designated by the department. </li><li>Meets QA standards designated by the department. </li><li>Assists leadership with special projects. </li><li>Performs other duties as assigned by the Supervisor. </li><li>Adheres to all network and departmental procedures and policies. </li><li>Adheres to and supports the network PRIIDE values and Standards of Behavior guidelines. </li><li>Completes annual educational requirements. </li><li>Maintains A/R to meet Network set goals. </li><li>Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim. </li><li>Participates in monthly conference calls with specific payers. </li><li>Follows appropriate steps to resolve insurance correspondence scanned into mail queues. </li><li>Follows appropriate steps to resolve denials within specified timeframe. </li><li>Individuals may not perform all of these duties, or may perform additional, related duties not listed here. </li></ul> <p>Demonstrates the following competencies:</p> <p>Attitude/Customer Competencies</p> <ul> <li>Caring, compassionate, and approachable in all customer contacts </li><li>Privacy - respects customers' right to privacy and modesty </li><li>Confidentiality - maintains customers' confidentiality </li><li>Telephone etiquette - speaks so that customers hear a smile </li><li>Appearance - takes personal ownership in appearance and that of work environment </li><li>Initiative - takes necessary steps to fix problems immediately </li><li>Providing Direction and Customer Acknowledgment - provides personalized attention by being courteous, friendly, and helpful when responding to customers' needs </li><li>Timely service - recognizes that customers' time is very valuable; provides them with prompt service </li><li>Customer information/education - provides customers with the best information needed to make informed choices </li></ul> <p>Relationship Competencies/Work Group Competencies</p> <ul> <li>Demonstrates advocacy, respect and truth telling </li><li>Demonstrates accountability for own actions </li><li>Demonstrates ability to respectfully address interpersonal conflicts </li><li>Takes initiative to help others </li><li>Demonstrates a learning attitude toward solving problems </li><li>Demonstrates openness to change and new learning </li><li>Reports to work on time and has regular attendance </li><li>Adheres to practice defined dress code </li><li>Attends Staff meetings </li></ul> <p>Ethical Decision-Making</p> <ul> <li>Respects the needs, expectations and rights of all individuals </li><li>Advocates the rights of all to a safe environment </li><li>Uses sensitivity to cultural diversity to guide decision-making </li></ul> <p>Performance Improvement</p> <ul> <li>Identifies work processes and strives to reduce cost and increase satisfaction </li><li>Identifies customers and demonstrates understanding of customers' expectations </li><li>Actively works to increase satisfaction of all </li><li>Monitors customers' satisfaction </li><li>Takes active role in department process improvement efforts; demonstrates understanding of outcomes </li><li>Demonstrates an understanding of responsibilities </li><li>Demonstrates diagnostic thinking/reasoning </li><li>Utilizes feedback from peers, supervisor, customers to drive performance and behaviors </li></ul> <p>(KNOWLEDGE, SKILLS & ABILITIES)</p> <ul> <li>Ability to analyze data involving many variables and convert to actionable information </li><li>Ability to be detail oriented </li><li>Ability to continuously develop and improve ones self </li><li>Ability to extract information from medical records to support claim appeals. </li><li>Ability to independently manage time and priorities </li><li>Ability to independently resolve problems </li><li>Ability to use customer service skills to provide an exceptional experience </li><li>Ability to utilize Microsoft Office Suite </li><li>CPT and ICD-10 coding; knowledge of commercial and governmental rules </li><li>Knowledge of documentation requirements, coding guidelines as well as government and commercial payer rule and edits. </li><li>Ability to communicate effectively both orally and in writing </li></ul> <p>Requirements</p> <p>MANDATORY LICENSE/REGISTRATION/CERTIFICATION:</p> <p>CPR (Cardio-Pulmonary Resuscitation)</p> <p>CERTIFICATION/LICENSE: None required.</p> <p>ADDITIONAL LICENSURE/CREDENTIAL REQUIREMENTS:</p> <ul> <li>High School Diploma or GED required. </li></ul> <p>ADDITIONAL EDUCATION AND EXPERIENCE REQUIREMENTS:</p> <ul> <li>2+ years: 2 years or more years' experience in revenue cycle healthcare within a medium to large health care system. Must be knowledgeable regarding payer billing guidelines and hospital and physician claim form billing requirements. (Required) </li><li>Medical billing experience is required. </li><li>Mandatory Continuing Education: Customer Service, Fire and Safety, Corporate Compliance (including Confidentiality), Infection Control, and education required by regulatory, accreditation bodies, scope of practice, and/or Hancock Regional Hospital. </li></ul>