Patient Account Representative 1.0 Fte

9010.80

1. Performs pre-billing and billing functions to insure successful outcome of claim submission and payment.
2. Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance.
3. Collaborates with all Team Members within SPH to insure an accurate and timely billing.
4. Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership
5. Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals.
6. Evaluate partial payments to determine if further reimbursement is valid
7. Compose technical denial arguments for reconsideration, including both written and telephonically
8. Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
9. Escalate exhausted appeal efforts to Leadership
10. Submits retro authorization to insurance within insurance carrier guidelines
11. Researches and takes necessary action to follow up on unpaid claims using ATB's and/or assigned work lists
12. Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse
13. Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess
14. Use effective documentation standards that support a strong historical record of actions taken on the account
15. Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application.
16. Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation
17. Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports.
18. Works patient and insurance correspondence timely.  Respond and document in account and scan documents into Patient Account for future reference.
19. Response to all queries timely to insure Gold Standard Customer Service
20.  Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations

KNOWLEDGE/EXPERIENCE:

• Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory
• Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory
• Proficient keyboard/ 10 key skills and working knowledge of computers required. 
• Good verbal and written communication skills.
• Strong data entry, ten key skills and working knowledge of computer required. 
• Exceptional customer service and interpersonal communication skills.
• Proficient in examining documents for accuracy and completeness.
• Ability to multitask and manage time effectively.
• Ability to grasp, retain, and apply new regulations
• Mathematical, organization skill and business correspondence skills.
• Basic knowledge in downloading/creating spreadsheets in Microsoft Excel

EDUCATION:    High School diploma or GED required.

                        Completes Patient Financial Services I training within first 5 month

LICENSE/CERTIFICATION/REGISTRY:

APTITUDES:

• Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers.
• Possesses interpersonal/communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations.
• Open to feedback and a changing environment, which requires flexibility in scheduling and department assignments.
• Create, maintain, and promote a respectful work environment consistent with SPH patient and employee standards.
• Ability to make decisions and troubleshoot using various resources available.
• Attention to detail and accuracy
• Ability to accurately, and efficiently document customer interactions
• Must possess a customer-focused mindset. 

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

Criminal background check

Reference checks

Drug Screening