The Patient Account Representative is responsible for processing all assigned patient accounts from initial billing to collection of all amounts due from each of the patient’s insurance carriers. Be in accordance with established departmental and Health Systems policies, procedures, and standards.
- Post all payments and contractual adjustments received from insurance carriers.
- Drops secondary claim for billing staff if required and initiates self-pay letter.
- Verifies insurance payments to ensure correct amounts are received. Calculates appropriate contractual allowances for insurance providers, prepares adjustment form and posts to patient account. Post management, employee discount and series account adjustments and corrects posting errors when necessary.
- Prepare refund requests for billing staff upon the biller’s reconciliation of the account.
- Verify posting and adjustments for automatic remittance posting, to include HMSA, Medicaid, and Medicare.
- Relieves cashier for vacations, lunch and breaks as required.
- Conducts follow up on outstanding insurance accounts, as requested by supervisor. Investigates insurance amounts to determine reason for non-receipt of payments, and follows up with insurance carrier.
- Maintains confidentiality of employee, patient, and Health System information.
- Maintains Health System core values of quality, caring, ownership, pride, teamwork, respect, and responsibility.
- Sends insurance information inquiries and group insurance forms to patients for completion; follows up on forms not returned.
- Performs other duties as assigned by the Business Office Manager.
Education and License:
High School Diploma or equivalent, required.
Clerical work, preferred.
Billing and/or collections work highly desirable.
Experience working with computers preferred; or any combination of education and experience, which would provide the necessary knowledge, skills and abilities to meet the minimum qualifications to perform the essential functions of this position.
- Basic typing skills with accuracy and 10-key by touch
- Must be detailed oriented and accurate in working with figures.
- Able to clearly and effectively communicate both verbally and writing.
- Requires flexibility, tact, and sensitivity in dealing with the public and other personnel, and able to maintain confidentiality of patient records.
- Must be able to work as an effective member of the healthcare team, and to establish and maintain cooperative working relationships with others, utilizing tact and diplomacy.
- Requires maintaining confidentiality of patient and Health System information.
- Requires verbal communication with insurance carriers, patients, physicians, co-workers, and personnel from other departments in person and over the phone.
- Requires reading billing requirements and regulations, medical reports, and other written materials.
Works indoors in an air-conditioned environment.
Frequent use of computer and phone, and other standard office machines. Must be able to stand, sit, stoop, twist, kneel, reach, push, pull using proper body mechanics and move/lift varying amounts of weight to a maximum of 50 lbs.