Patient Account Representative III

Job Summary

The Patient Account Representative III is responsible for processing assigned patient accounts from initial billing through the collection of all amounts due from each patient’s insurance carriers. All work must be completed in accordance with established departmental and Lower Umpqua Hospital District policies, procedures, and standards.

Essential Duties

• Ensure data accuracy and complete account checks, tasks, denials, and credit balance worklists in Meditech.
• Ensure data accuracy and complete claim checks, holds, rejections, and return-to-provider items in Ability.
• Release claims to the correct payer for appropriate processing.
• Submit CMS-1500 and/or UB-04 claim forms manually or electronically to insurance carriers in a timely manner.
• Use insurance portals to verify account eligibility, review claim processing, manage claim appeals, and locate explanations of benefits when necessary.
• Follow up on outstanding claims to obtain reimbursement.
• Submit appeals and reconsideration requests to insurance companies for claim reprocessing.
• Investigate and resolve problems affecting claim processing and identify recurring trends.
• Notify the Business Office Manager and/or Lead of claim-processing issues and related trends.
• Create clear and concise denial letters.
• Work Age Trial Balance reports as directed by the Lead and/or Business Office Manager.
• Respond to telephone inquiries from patients, insurance carriers, and physicians regarding accounts.
• Work independently and collaboratively with other team members.
• Verify insurance reimbursements to ensure the correct contracted amounts are received.
• Calculate and submit appropriate adjustment requests for processing.
• Review credit-balance accounts and take appropriate action, including preparing adjustment requests or processing refunds.
• Document the status, actions taken, 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 practices that support cash receivables and patient satisfaction.
• Maintain the confidentiality of employee, patient, and Health System information.
• Attend meetings and mandatory in-service training as required or requested.
• Support the Health System’s core values of quality, caring, ownership, pride, teamwork, respect, and responsibility.
• Participate in departmental performance-improvement activities.
• Perform other duties as assigned by the Business Office Manager.

Qualification Requirements

Education and License

• High School Diploma or equivalent preferred.

Experience

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

Additional Qualifications

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

Work Environment

Works indoors in an air-conditioned office 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. Must also be able to move or lift varying amounts of weight up to a maximum of 20 lbs.

Schedule

• Full-time position.

Benefits

• Eligible for the hospital’s comprehensive employee benefits package.