Patient Account Representative

Overview:

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities:

The Patient Account Rep I is responsible for posting all incoming payments to correct patient accounts on a daily basis.  Inputs and retrieves data from computer systems.  Reconciles accounts daily. Applies payments to patient accounts accurately and efficiently. Distribution of all billing to appropriate personnel.  Reviews and performs follow-up on all authorizations, and specialty referrals. Maintains a current knowledge of contracts and state Worker’s Compensation fee schedules.  Responsible for the handling of incoming and outgoing mail pertaining to the hospital.  Needs to have ability to recognize and correct mailing errors immediately.  Always uses proper tact and discretion in handling inquiries from patients and their families. The Patient Account Rep I is responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received.  Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement of Hospital’s receivables.  Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment.  Utilizes and applies the appropriate California and Federal regulations in order to assure compliance in payment practices. Responsible for posting all incoming payments to correct patient accounts on a daily basis.  Inputs and retrieves data from computer systems.  Reconciles accounts daily. Applies payments to patient accounts accurately and efficiently. Applies contractual adjustments to patient AR balances as needed. Manage and forward underpayments /denials to the appropriate departments for follow-up and further revenue collection as needed.

Qualifications:

EDUCATION, EXPERIENCE, TRAINING

 

1.    Ability to multi-task, prioritize needs to meet required timelines

2.    Analytical, mathematical  and problem-solving skills required

3.    Customer Services experience required

4.    Effective written and verbal communication skills

5.    Experience in accounts payable, accounts receivable or cashier experience preferred

6.    Familiar with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology is preferred

7.    High School Graduate or GED Equivalent  Required  (effective 4/1/14 for all new hires)

8.    Knowledge of basic understanding medical coding and third-party operating procedures and practices

9.    Knowledge of multiple insurance billing requirements and 6 mo.-1 year of billing experience required

10.  Medical and Insurance terminology essential

Pay Transparency:

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.12 to $28.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status: Full Time Shift: Days Equal Employment Opportunity: Privacy Notice:

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf