Patient Accounts Representative

Patient Accounts Representative

Job Summary

The Patient Account Representative works in the Business Office and is responsible for following up on unresolved patient claims; taking the necessary steps to ensure prompt and accurate payment; and responding to and resolving patient inquiries. In addition, the Patient Account Representatives posts incoming payments from Insurance Companies and / or patients to the Patient’s account(s).

Essential Duties and Responsibilities

• Answer telephones and assist patients and others coming into the Business Office
• Respond promptly to inquiries, concerns and problems related to patient billing.
• Maintain a positive dialogue when working with patients or family members on making financial arrangements to pay hospital bills, including assistance in completing charity applications.
• Note patient accounts as appropriate – post insurance and / or patient payments to CPSI.
• Review with managers, any issues which may lead to non-compliance or reduced reimbursement.
• Review system reports to identify delinquent and credit balance accounts.
• Take the appropriate and necessary action to have the claim resolved, including negotiating settlements with the insurance company.
• Promptly review patient correspondence (letters, emails, etc.) and take the necessary action.
• Count and balance the cafeteria and registration money daily.
• Provide support on special projects related to improving the revenue cycle.
• Identify process and system issues and makes recommendations to become more efficient.
• Maintain thorough and detailed knowledge of hospital revenue cycle including insurance, self-pay, and third-party payers.
• Exhibit an understanding of federal, state, and contractual guidelines / regulations as it relates to Medicare, Medicaid, Managed Care and Commercial Insurance companies to ensure ongoing compliance.
• Demonstrate thorough knowledge of CPSI and Microsoft Office.
• Work with other departments to ensure charges are correct and insurance information and discharge dates are in entered into CPSI correctly and make corrections, if not.
• Process outgoing mail.
• Protects patient privacy and confidentiality in accordance with HIPAA and privacy laws.
• Ensures patient satisfaction, including troubleshooting when there is a complaint and developing process improvements to prevent reoccurrences.
• Demonstrates clear ownership of workplace and patient safety.
• Report mistakes, near misses, adverse events and quality and safety concerns.
• Participates in the development and implementation of safety and quality improvement activities.
• Other duties as may be assigned.

Job Requirements

Education : High School Diploma or GED required. Associates degree preferred.

Certification / Licensure :

Experience : 2-4 years of experience in a medical facility, or with health insurance, or related area. Knowledge of function and relationships within a hospital environment preferred. Advanced customer service skills and experience required. Ability to work in a fast paced environment. Excellent oral communication and customer service skills required. Ability to use proper negotiation techniques to professionally collect money owed by our Patients. Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy.

Physical Requirements : Ability to sit for long periods of time; occasional standing and walking. The ability to frequently lift up to 50 lbs. Frequent stooping, bending, and reaching. Good visual acuity.

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