Patient Accounts Representative - Billing

Responsibilities include accurate billing of hospital and/or professional accounts, ensuring timely claim submission, and reimbursement from various third-party payers, ensuring proper account documentation, charging and refund activities in the hospital’s electronic billing system and pursuing follow-up efforts on open accounts.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Under the general direction of the Director, Accounts Receivable, the direct supervision of the Team Leader/Supervisor, Manager and within established departmental policies and procedures, the incumbent performs the following functions:

1. Works daily electronic billing work queues and paper claims submission by resolving payer edits and mailing/releasing claims to the clearing house or third party payers.

2. Documents billing activity on the account; ensures compliance with all applicable billing regulations for assigned payers and reports any suspected/questionable compliance/billing concerns to the attention of department leaders.

3. Reviews and corrects all claim denials that are communicated via Explanation of Benefits (EOB), denial reports, denial management system or correspondence from the insurance carrier or others to determine what follow-up action is necessary including initiating the adjustment or appeals process if needed.

4. Reviews and processes all required daily reporting activities including late charges, diagnosis changes, charge corrections and initiates corrected bills to the payer as needed.

5. Determines proper disposition of credit balances and take backs (from payers) on accounts and initiates refunds, adjustments or corrected claims.

6. Monitors claim rejections for trends and issues, reports these findings to the team lead/manager to reduce future claim rejections.

7. Performs follow-up on unresolved open accounts and documents all reasons for reimbursement delays as well as actions taken within the electronic billing system.

8. Monitors workload for aging inventories and timely filing.

9. Practices excellent customer service skills by answering patient, internal associates and third-party questions and/or addressing billing concerns in a timely, professional and efficient manner.

10. Use payer websites, portals, claims processing system to verify eligibility, review claim status, initiate adjustments, submit appeals etc.

11. Purges hardcopy files as needed.

12. Participate in general or special assignments and attend all required team meetings and required training.

13. Participates in appropriate role in disaster and fire drills, fires and other emergency situations.

14. Maintains confidentiality of all employee, legal, patient and company matters.

15. Performs similar or related duties as assigned or requested.

WORK SCHEDULE: (Hybrid - after successfully completing probation period of 90 days)

• Generally Monday through Friday, days.

• Ability to adjust schedule to meet the needs of the organization.

Education:

• High school diploma or equivalent required.

• Associate degree preferred

Experience:

• Minimum 1-2 year’s medical billing experience in a health care setting preferred.

• Knowledge of basic patient accounting processes and healthcare terminology strongly preferred