PAR III

Job Summary

The Patient Account Representative III is responsible for processing all assigned patient accounts from initial billing through collection of all amounts due from each patient’s insurance carriers, in accordance with established departmental and Health System policies, procedures, and standards.

Essential Duties

• Ensure accuracy of data and complete account checks, tasks, denials, and credit balance work lists in Meditech.
• Ensure accuracy of data and complete claim checks, holds, rejections, and RTP in Ability, releasing claims to the correct payor for appropriate processing.
• Manually or electronically submit 1500 and/or UB04 claim forms to insurance carriers in a timely manner.
• Use insurance portals to verify account eligibility, review claim processing, work claim appeals, and locate explanations of benefits (EOBs) when necessary.
• Conduct follow-up for reimbursement on outstanding claims.
• Conduct appeals and reconsiderations with insurance companies for reprocessing insurance claims.
• Investigate, problem-solve, and identify trends preventing claims from processing, and notify the Manager and/or Lead of related issues.
• Create clear and concise denial letters.
• Work Age Trial Balance (ATB) reports as directed by the Lead and/or Manager.
• Respond to phone inquiries from patients, insurance carriers, and physicians regarding accounts.
• Work independently or collaboratively within the department.
• Verify insurance reimbursement to ensure correct contracted amounts are received and calculate and submit appropriate adjustment requests for processing.
• Review credit balance accounts and take appropriate action, including preparing adjustment requests or processing accounts for refunds.
• Document in detail the status and expected resolution of each account worked.
• Generate letters to patients when insurance carriers request additional information from the insured.
• Collaborate with leaders, team members, and other departments to establish best-practice procedures throughout Lower Umpqua Hospital District and support cash receivables and patient satisfaction.
• Maintain confidentiality of employee, patient, and Health System information.
• Attend meetings and all mandatory in-services as required or requested.
• Maintain Health System core values of quality, caring, ownership, pride, teamwork, respect, and responsibility.
• Participate in department performance improvement activities.
• Perform other duties as assigned by the Business Office Manager.

Qualification Requirements

Education and License

• High School graduate or equivalent preferred.

Experience

• Previous clerical work experience preferred.
• Minimum of two years of billing and/or collections experience highly desirable.
• Experience working with computers and Microsoft Office Suite required.
• Any combination of education and experience that provides the necessary knowledge, skills, and abilities to meet the minimum qualifications and perform the essential functions of the position.

Additional Qualifications

• Basic typing skills with accuracy and 10-key by touch.
• Strong attention to detail and accuracy when working with figures.
• Ability to communicate clearly and effectively both verbally and in writing.
• Flexibility, tact, and sensitivity when dealing with the public and other personnel, with the ability to maintain confidentiality of patient records.
• Ability to work effectively as a member of the healthcare team and establish cooperative working relationships using tact and diplomacy.
• Ability to communicate verbally with insurance carriers, patients, physicians, co-workers, and personnel from other departments both in person and over the phone.
• Ability to read and understand billing requirements and regulations, medical reports, and other written materials.

Work Environment

Works indoors in an air-conditioned environment.

Physical Demands

Frequent use of computers, telephones, and other standard office equipment. Must be able to stand, sit, stoop, twist, kneel, reach, push, and pull using proper body mechanics, and move or lift varying amounts of weight up to a maximum of 20 lbs.

Schedule

• Full-time position.

Benefits

• Eligible for the hospital’s employee benefits package.