POSITION TITLE: Patient Account Representative III
Reports to: Business Office Manager
Last Revised/Reviewed/ Approved by HR: 11/30/2022
The Patient Account Representative III 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.
- Ensures accuracy of data, complete account checks, task, denial and credit balance work list in Meditech.
- Ensures accuracy of data, complete claim checks, hold, rejections and RTP in Ability, release claims to correct payor for appropriate processing.
- Manually or electronically submits 1500 and/or UBO4 claim forms in a timely manner to insurance carriers for processing
- Working knowledge of insurance portals to ensure account accurate eligibility, verify claims processing, work claim appeals and locate explanation of benefit (EOB) when necessary.
- Conducts follow up for reimbursement on outstanding claims.
- Conducts appeals and reconsiderations to insurance companies for reprocessing insurance claims.
- Investigates, problem solves and identifies trends that are keeping claims from processing. Notifies Manager and/or Lead of related issues.
- Responsible for creating clear and concise denial letters.
- Responsible for working Age Trial Balance (ATB) reports as directed by Lead and/or Manager.
- Responsible phone inquiries from patients, insurance carriers, and physicians regarding accounts.
- Works independently or in a collaborative work environment.
- Verifies insurance reimbursement to ensure correct contract amounts are received. Calculate and perform appropriate adjustment request for processing.
- Review credit balance accounts taking appropriate action, e.g., prepares an adjustment request, or processes account for refund.
- Document in detail each account worked on status and resolution expectation.
- Generates letters to patients when insurance is requesting additional information from the insured.
- Works collaboratively with Leaders, Team Members and other departments establishing best practice procedures throughout Lower Umpqua Hospital District to ensure cash receivables and patient satisfaction is met.
- Maintains confidentiality of employee, patient, and Health System information.
- Attends meetings and all mandatory in-services as required or requested.
- Maintains Health System core values of quality, caring, ownership, pride, teamwork, respect, and responsibility.
- Participates in performance improvement activities of the department.
- Performs other duties as assigned by the Business Office Manager.
Education and License:
High School graduate or equivalent, required.
Previous clerical work experience, preferred.
Minimum of 2 years of billing and/or collections work, highly desirable.
Experience working with computers and Microsoft Office Suite, required.
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 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.