Patient Account Representative

VALLEY MEDICAL CENTER

JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Patient Account Representative

JOB OVERVIEW: This position is responsible for performing a variety of complex duties in support of reimbursement from the patient liability and insurance carriers for both hospital and professional claim adjudication. As a Patient Account Representative, you will be a guiding force behind efficient patient billing and account management. Your responsibilities will span the entire account lifecycle - from processing claims and collecting payments to resolving issues and addressing patient inquiries with empathy and clarity. This position requires substantial knowledge and execution of third-party payer policies. Experience in patient liability management, collections, and communication proficiency is also required.

DEPARTMENT: Patient Financial Services

WORK HOURS: 8:00 am to 5:00 pm, Monday - Friday or assigned.

REPORTS TO: Manager, Patient Financial Services

PREREQUISITES:

• Associate (2 year) degree required or equivalent experience, college (4 year) degree preferred.

• Minimum three years of equivalent work experience in a hospital, medical office/clinic business office, or insurance company and experience with billing and collections, required.

• Comprehensive working knowledge of third-party insurance processes, patient collection processing, complex remittance processing, and excellent customer service skills, required.

• Demonstrated knowledge of medical terminology and abbreviations.

• Demonstrated knowledge of Microsoft, Word, Excel, and Outlook.

• Prior Epic Resolute Hospital and Professional experience preferred.

QUALIFICATIONS:

• Excellent organizational and time management skills.

• Excellent written and verbal communication skills.

• Intermediate technical skills including PC and MS Outlook.

• Advanced knowledge of Explanation of Benefits (EOB) for both the UB-04 for Hospital Billing and HCFA 1500 for Professional Billing.

• Advanced knowledge of insurance billing, collections, and insurance terminology.

• Extensive knowledge of third-party reimbursements from commercial insurance companies, government payers, and other third-party specialty payers.

• Is flexible, adaptable, and can effectively cope with change.

• Demonstrates effective communication and interpersonal skills with a diverse population.

• Demonstrates the ability to communicate with tact, poise, courtesy, respect, and compassion.

• Able to prioritize tasks, carry out assignments independently and within a team, and to practice good judgment.

• Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations.

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS:

See Generic Job Description for Administrative Partner.

PERFORMANCE RESPONSIBILITIES:

A. Generic Job Functions: See Generic Job Description for Administrative Partner

B. Essential Responsibilities and Competencies:

• Maintains knowledge of payer requirements as a fundamental business practice responsibility under Valley Medical Center''s Corporate Compliance program.

• Is familiar with VMC Patient Accounts payment policies and procedures including VMC financial assistance programs.

• Demonstrates the awareness of the importance of cost containment for the department. Provide suggestions regarding process or quality improvement opportunities to department manager.

• Requests Financial Assistance adjustments, administrative adjustments, and requests contractual allowance corrections per policy.

• Works with patients regarding options for self-pay account balances, payment arrangements, and refers patients to financial counselor when appropriate.

• Receive inbound and make outbound calls to respond to and resolve questions from patients, their families, insurance companies, attorneys, or any other entity or individual.

• Responsible for accurate and timely billing of UB / HCFA claims for all insurance/government payors. To include primary, secondary, and tertiary billing.

• Understands and adheres to all federal, state, and local payer-billing requirements.

• Utilizes payer / provider instruction manuals and bulletins, hospital policy / procedures, and other resource materials to gain information to submit ";clean"; claims.

• Reviews the payer rejections (837 transaction sets), UB and 1500 claim forms that have been rejected by the electronic billing system. Corrects errors and releases for transmission.

• Reviews Explanation of Benefits (EOB''s) and vouchers, to pursue payment of claims.

• Responsible for editing patient insurance information on accounts in accordance with the Insurance Carrier Change Policy and Procedure.

• Contacts insurance company/ third parties, patients, physicians, and/or departmental staff to obtain necessary or missing information, and to collect outstanding payments.

• Responsible to follow-up with the appropriate payer for claims status.

• Identify, analyze, and resolve payment barriers.

• Corrects data in payer systems such as Medicare and Medicaid

• Research & resolve underpaid claims in collaboration with contracting department.

• Research and appeal denied claims from payers to determine steps necessary to secure payment.

• Take patient payments by phone or in person.

• Explains policies and procedures to customers, solves problems independently and as part of a team.

• Responsible for the daily reconciliation of cash to verify that it balances with the daily bank deposit.

• Responsible for processing other department deposits within 24 hours of receipt.

• Demonstrated knowledge of the current functionality of patient accounting systems

• Coordinates non-compliant or disputed denials with Clinical Audit & Appeals Manager.

• Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim.

• Escalates problem accounts to Manager when appropriate intervention is required.

• Performs all job functions in a manner consistent with Valley''s expectations as defined in Valley Values.

• Works collaboratively and promotes an amicable working environment developing effective working relationships with key associates (HIM, Patient Access, Clinic Network, and Hospital Departments)

• Maintains confidentiality of all protected health information.

• Returns all phone calls within 24 hours of receipt of message.

• Adheres to policies and procedures as required by VMC.

• Participate in and attend meetings and training as required.

• Regular and punctual attendance is a condition of employment.

• Notify PFS Director and Manager when new insurance regulations are

identified.

• Completes documentation of daily activities for individual productivity tracking and for patient account volume management.

• Performs other related job duties as required.

Created: 1/25

FLSA: NE

Grade: OPEIUE

CC: 8531

Job Qualifications:

PREREQUISITES:

• Associate (2 year) degree required or equivalent experience, college (4 year) degree preferred.

• Minimum three years of equivalent work experience in a hospital, medical office/clinic business office, or insurance company and experience with billing and collections, required.

• Comprehensive working knowledge of third-party insurance processes, patient collection processing, complex remittance processing, and excellent customer service skills, required.

• Demonstrated knowledge of medical terminology and abbreviations.

• Demonstrated knowledge of Microsoft, Word, Excel, and Outlook.

• Prior Epic Resolute Hospital and Professional experience preferred.

QUALIFICATIONS:

• Excellent organizational and time management skills.

• Excellent written and verbal communication skills.

• Intermediate technical skills including PC and MS Outlook.

• Advanced knowledge of Explanation of Benefits (EOB) for both the UB-04 for Hospital Billing and HCFA 1500 for Professional Billing.

• Advanced knowledge of insurance billing, collections, and insurance terminology.

• Extensive knowledge of third-party reimbursements from commercial insurance companies, government payers, and other third-party specialty payers.

• Is flexible, adaptable, and can effectively cope with change.

• Demonstrates effective communication and interpersonal skills with a diverse population.

• Demonstrates the ability to communicate with tact, poise, courtesy, respect, and compassion.

• Able to prioritize tasks, carry out assignments independently and within a team, and to practice good judgment.

• Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations.