Patient Account Rep 1

Scotland Health Care System in Laurinburg, North Carolina•Laurinburg, NC

2d•Onsite

About The Position

Scotland Health Care System is seeking a dedicated Patient Account Representative 1 to join their Patient Financial Services team. This full-time position involves examining denied and underpaid claims, communicating with payers to resolve discrepancies, and analyzing denial reasons. The role requires maintaining knowledge of federal and state regulations, specific payer requirements, and explanation of benefits to identify and report billing compliance issues. The representative will also update and maintain payer files, document interactions, and handle communication with payers and internal departments. Continuous quality improvement, initiative, and resourcefulness are expected, along with cross-training in other Patient Accounts areas and participation in HBI Revenue Cycle classes. Compliance with HIPAA guidelines is essential. The organization, founded in 1946, is a community-owned, not-for-profit system serving Laurinburg, North Carolina, with a mission to deliver safe, high-quality, compassionate, and sustainable healthcare. They offer a full spectrum of services and foster a culture of caring for both patients and employees.

Requirements

Knowledge of federal and state regulations.
Understanding of specific payer requirements and explanation of benefits.
Ability to identify and report billing compliance issues and payer discrepancies.
Proficiency in updating and maintaining accurate payer files.
Skill in documenting all interactions with payers.
Effective communication skills (telephone and email).
Ability to participate in continuous quality improvement efforts.
Demonstrates initiative and resourcefulness.
Willingness to be cross-trained in other areas within Patient Accounts.
Willingness to begin HBI Revenue Cycle classes.
Understanding and maintenance of compliance with HIPAA guidelines.

Responsibilities

Examines denied and underpaid claims to determine reasons for discrepancies.
Provide payers with specific reasons for the suspected underpayments and analyzes denial reasons given by payers.
Works with management to identify, trend and address root causes of denials; helps pinpoint strategies for reducing AR.
Maintains a thorough knowledge and understanding of federal and state regulations, as well as specific payer requirements and explanation of benefits, in order to identify and report billing compliance issues and payer discrepancies.
Updates and maintains accurate files on each payer including contact names, addresses, phone numbers, web sites and other pertinent information thoroughly documents all interactions with payers.
Effectively handles all communication, including telephone and email from payers and departments within Revenue Cycle.
Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with manager and tracking progress (attends huddles).
Demonstrates initiative and resourcefulness by making recommendation and communicating trends and issues to management.
Crossed trained in other areas within Patient Accounts.
Begin HBI Revenue Cycle classes.
Understands and maintains compliance with HIPAA guidelines when handling patient information.
Performs other duties as assigned.