Patient Account Representative Ii

About The Wilshire Group

The Wilshire Group, a renowned boutique consulting firm in Los Angeles, specializes in revenue cycle optimization and fostering effective collaboration between operational and IT facets. With a robust track record of aiding over 100 healthcare systems nationwide, our team thrives on professionalism, efficiency, and adaptability.

Our core values- professionalism, efficiency, and flexibility- underscore our commitment to creating an inclusive and dynamic workplace. We embrace diverse narratives and believe in offering opportunities to exceptional individuals who bring their best to the table.

We are currently offering a contracted interim position at one of US News Best Hospitals 2022-23. This position caters to top performers seeking a professional environment that acknowledges and values their dedication and proficiency. While this role doesn't offer benefits, it presents an opportunity to work within an organization that encourages talented individuals to surpass conventional boundaries.

Join us at The Wilshire Group, a place where talented professionals find a home to showcase their skills and contribute meaningfully to the healthcare landscape.

Why Wilshire? Employee Testimonial

"The number of RCM subject matter experts I get to work with each day is unreal. Working alongside and as part of this team to help shape the RCM space is exciting."-Patti Consolver, Director of Business Development

This is a contracted position for 6+ months. This position offers $27.00-$29.00 per hour.

Job Summary

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Contractors must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient's rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Contractors must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions.

• Account Reps: Follows up on unpaid accounts in Patient Accounting systems with the payers either by phone or via websites. Works payer denials based on claim process adjudication; Review accounts for possible underpayments; research contracts, guidelines and resolve

payment with payer. Perform appeals with payer. Performs bad debt request transfers as applicable. Performs or requests adjustment and contractual write offs as applicable.

• Billers: Reviews EPIC worklists and edits accounts as needed; Reviews Cirius claim edits and resolves edits; Reviews and resolves electronic acknowledgement payer rejections/denials; Rebills claims based on requests from Follow Up reps due to denials received. Resends claim as needed.
• Cash Posting Reps: Posts payments; Work EPIC undistributed payment worklist; Posts adjustments related to payments. Processes refunds for accounts payable. Posts payment transfers from professional billing to hospital billing.
• Data Control Reps: Enters charges; Reviews EPIC worklist accounts with charge issues and resolves; Research charge issues and follows up with departments as needed. Complete charge corrections including adding diagnosis, transferring or reversing charges, combining accounts.
• Patient Advocacy Reps: Completes and processes charity applications; Reviews and validates high dollar self-pay accounts before outsourcing to outside vendor; Handles patient calls and complaints. Requests referral of accounts to bad debt as applicable.
• Maintains professional communication with various PFS staff, medical center staff, payors, physicians, and patients regarding the billing of services rendered at Stanford Medical Center. Communication may consist of telephone, correspondence, or in person contact.
• Meets weekly individual productivity goals and standards while following planned priorities as set by the Team.
• Manager/Coordinator

MINMUM QUALIFICATIONS

Education Qualifications

• High school diploma or GED equivalent

Licenses and Certifications

N/A

Experience

• Two (2) years of progressively responsible and directly related work experience
• We require 2-3 years of professional billing and Epic experience in PB billing

KNOWLEDGE/SKILLS & ABILITIES

• Ability to follow oral and written instructions and interpret institutional and other policies accurately •
• Ability to gather, analyze, and display data in appropriate format and keep accurate records
• Ability to maintain confidentiality of sensitive information
• Ability to perform basic mathematics
• Ability to plan, prioritize and meet deadlines
• Ability to work effectively with individuals at all levels of the organization
• Knowledge of accounts receivable system like SMS, IDX, or Meditech
• Knowledge of computer systems and software used in functional area
• Knowledge of medical reimbursement policies and procedures Knowledge of medical terminology and insurance claim procedures common to medical billing and accounts receivable operations
• Knowledge of one or more of the following: Medicare, Medi-Cal, Worker's Comp or Managed Care (HMO,PPO,POS, etc)
• Knowledge of principles and practices of customer service and telephone courtesy
• Knowledge of computer systems and software used in assigned work area