The Patient Account Representative III – Self Pay (PAR III), under supervision of the Business Office Manager, will be responsible for collections of patient accounts both uninsured self-pay accounts, and self -pay after insurance is processed. This includes certain administrative functions when an account is at collections and recovered for Medicare Bad Debt logging. The PAR III-Self Pay assesses financial circumstances and assists with access to various LUHD financial assistance programs. This includes but is not limited to: completion of forms, explanation of policies and processes, and filing requirements including presumptive Medicaid assistance. The PAR III – Self Pay will assist in answering questions or concern patients may have regarding billing and payment expectations or transfer to Billing/Patient Accounting if appropriate. The PAR III – Self Pay will have knowledge of all aspects of the department from registration to billing and collection or otherwise know which area to seek assistance from.
- Maintains compliance with all HIPAA requirements.
- Answers incoming telephone calls and returns voicemails daily.
- Calculates and collects payments from patients in person and on the phone.
- Thoroughly and timely works accounts in work queues as defined by policies and procedures.
- FC MDC Pending
- FC Accident Dx & Self Pay
- FC Expiring Application
- FC FA Under Review
- FC In-House Self-Pay
- FC Needs Info letter
- FC Adjustment needed
- Pre-Bad Debt Accounts
- No future collection events
- SP unapplied events
- Demonstrates the ability to analyze patient account information for patient account issue resolution. Has exceptional knowledge of insurance benefits and standard medical billing protocols used to determine a patient’s financial responsibility.
- Determines a patient’s active insurance coverage by using all available resources to accurately record and update information in the patient’s account, and updates claims to file to the correct insurance carrier.
- Communicates with Billing/Patient Accounting in order to help resolve issues, as appropriate. Notifies billing staff of any re-billing, charge adjustments, refunding or collection intervention that needs to occur.
- Processes statements including review, folding, stuffing statements accurately, include forms for payment plan and financial assistance.
- Review returned mail. Contact patient for updated address or send to collections.
- Set up arrangements/ monthly installment plans for patients to payoff balances within the guidelines of District collection policy.
- Applies appropriate adjustments for:
- Community uninsured
- Prompt pay
- Financial Assistance
- Process other negotiated discounts
- Assesses patient’s insurance benefits for individual that are uninsured and underinsured to determine whether the patient may be eligible for financial assistance or community uninsured discounts.
- Maintains complete records of all patients applying for indigent or financial assistance. Assists with applications, collecting proof of income, and any other applicable documentation.
- Follows up on partially completed applications.
- Reviews completed financial assistance applications and determines approval.
- Maintains a knowledge base of programs offered by LUHD such that assistance in applications, processing or contact to outside agencies is readily offered:
- Presumptive eligibility/ Certified OHP assist
- Financial Assistance Program including Charity
- Access One
- Western Mercantile Collection Agency
- Evolve Payment Plans (older accounts)
- Oregon Coast Billing Service Payment Plans
- Offer assistance with out-of-pocket costs through programs offered by pharmaceutical companies and other available means.
- Any additional programs that may be added in the future
- Provides price estimate for future services and creates a payment plan to resolve older debt.
- Process bad debt and OCB claims daily.
- Reconciliation of claims-confirming they received all accounts.
- Process and logs quarterly Medicare Bad Debt.
- No Surprises Act – CMS requirements.
- Provide good faith estimate in advance of scheduled services, or upon request.
- No balance billing for out-of-network emergency services.
- No balance billing for non-emergency services by nonparticipating providers at certain participating health care facilities, unless notice and consent was given in some circumstances.
- Disclose patient protections against balance billing.
- Monthly Agency Reports Reconciliation – (accounts sent, returned, collections, adjustments, etc.)
- Western Mercantile
- Other duties as required or assigned.
Education and License:
High School Diploma or equivalent, required.
Medical Terminology knowledge, preferred.
UB Revenue Code, ICD, and CPT/HCPCs knowledge, preferred.