Patient Accounts Representative

Are you passionate about healthcare and committed to ensuring a seamless financial experience for patients? Klickitat Valley Health is seeking a dedicated and compassionate Patient Account Representative to join our team. If you are driven by the desire to make a positive impact on the lives of individuals in a small community, we invite you to be an essential part of our healthcare family.

Full-time benefits include medical/vision/dental/RX, HSA/FSA, life insurance, long-term disability, retirement, and a generous amount of Paid Time Off.

Klickitat Valley Health is a rural, critical-access hospital located in scenic Goldendale, Washington only two hours from Portland along the breathtaking Columbia River Gorge. KVH offers emergency and acute inpatient care and a full scope of ancillary services including General Surgery, Diagnostic Imaging, Laboratory, Respiratory Therapy, PT / OT, Behavioral Health, Dental, Pain Management, Optometry and Hospice. The hospital also owns a busy, well-established primary clinic that is located on hospital campus. Inpatient care is managed by 24/7 Hospitalist staff. KVH employs over 300 staff.

GENERAL SUMMARY:

Under direct supervision the Patient Accounts Representative I performs routine medical billing functions to third party payers and ensures claims are completed in an accurate and timely manner. Reviews itemized bills to verify accuracy and completeness of charges and researches denied or incomplete bills. The Patient Accounts Representative researches and resolves patient complaints. May specialize in a general payer type or bill type such as Commercial, Government, Medicaid, Medicare, RHC providers or Motor Vehicle Accident. This position may also be responsible for initial encounter data entry.  This may include, but not limited to patient demographic entry, charge entry CPT-4 and ICD-10 coding and referrals to outside specialist. The Representative demonstrates excellence in customer service during interactions with employees, managers/supervisors, patients, patient family members, customers, insurance companies, etc. and works collaboratively with colleagues and departments throughout the organization to provide optimal care services in a professional, ethical and knowledgeable fashion. Maintains a safe, clean and organized work environment.

Minimum Education, Training & Experience (includes licenses or certifications):

Education:

• High school diploma or GED required. 

Experience:

• At least two (2) years office/administrative experience required including: familiarity with everyday office equipment

• One (1) year experience working in medical billing, A/R or accounting is preferred.

Skills/Knowledge/Abilities:

• Demonstrated knowledge of billing/collection rules and regulations.  

• Knowledge of online systems for eligibility and status review of claims.  

• Key Boarding:  40 wpm and PC based computer skills.  10 key proficiency.  

• Knowledge of medical terminology.  

• Works efficiently with minimal supervision, exercising independent judgment within stated guidelines. 

• Demonstrated effective interpersonal skills which promote cooperation and teamwork. 

•  Ability to withstand varying job pressures and organize/prioritize related job tasks.

• Promote the delivery of excellent customer service to both internal (patients and staff) and external customers (visitors and insurance companies). 

• Excellent time management, organizational and accuracy skills.

• Communicate effectively with patients, visitors, insurance companies and providers.

• Knowledge of every day computer electronic tools (e.g., email, data retrieval, voicemail, and internet/intranet), plus calculator, copier, fax, etc. 

• Proficiency with Microsoft Excel and Microsoft Word.

• Familiarity with file management.

• Ability to read, write, speak and understand English.

Essential Functions/Responsibilities (but not limited to):

• Edits bills to ensure accuracy and completeness, applying knowledge and understanding of Universal billing rules, regulations and claim form requirements.

• Reviews and completes necessary forms to ensure accurate billing.

• Checks patient demographic and insurance information.  May be required to verify insurance for some claims.

• Ensures correct calculations; ensures any charge entries, charge corrections or transfers are processed per guidelines and systems.

• Follows up for missing information, bundling edits and/or diagnosis codes.

• Ensures proper physician names and provider numbers are listed.

• Documents billing history and data for A/R Management.

• Submits claims electronically or files hard copy claims as appropriate.

• Determines what supporting documents (e.g., Medical Records, Explanation of Benefits, and Itemized Bill) should be included with claims and obtains if needed.

• Reviews and completes daily unbilled reports, late charge report and 72-hour reports; taking appropriate action on each claim to reduce billing delays and produce a bill. 

• Rebills upon request after reviewing account notes and determining action to be taken.

• Reviews all Patient Accounts, on-line directly, to assure all claims are in process for payment, makes corrections/changes on rejected claims on-line.

• May determine whether “split” bill is required and request proper billing.

• May process flag reports ensuring timely verification, rebill, and/or adjustment of claims based upon payer response.

• Provides accurate and quality Customer Service to internal and external customers regarding account status and pending actions.

• Answers all incoming telephone calls, voice mails, e-mails, faxes or personal requests in a professional manner.

• Interviews customer and assists appropriately.

• Works closely with providers, patients, and members of other departments. 

• Sets deadlines for future action on accounts. 

• Understands and applies the proper procedures for writing off adjustments of which Representative is authorized to make.  (Adjustment write-off authority varies according to specialty – may include Contractual, Routine, Bad Debt, Late Charges)

• Works effectively with large amounts of data and detail.  Generates or works from multiple reports.  Reports vary according to pay or specialty.

• Establishes secondary coverage status for Medicare insurance accounts to determine primary payment status of any other insurance.

• Checks and inputs information related to physician/provider status in Medicaid system in order to maintain billing eligibility for treatment and care given to patients that have Medicaid insurance.

• Runs an insurance payment tickler report daily in the billing software system to determine account payments by insurance category and the aging of account status for payment; reviews report for establishing account status. 

• Cross-train and provide coverage in other areas of the business office/patient financial services department as needed.

• Performs other duties as assigned.