Patient Account Representative II

#REF!•Arlington, TX

8d•Hybrid

About The Position

The Patient Account Representative II (PAR II) plays a crucial role in the healthcare revenue cycle, focusing on receivables management and collections. This position involves verifying account balances, researching payment and adjustment postings for accuracy, and independently resolving accounts. The PAR II will contact various parties, including payors, networks, patients, and employers, to secure timely and accurate payments. They will also handle claims with zero payment by acquiring necessary information and resolving payment variances using payor-specific contract terms. For clinical denials, the PAR II will refer claims to the Denials team and prepare appeal letters when appropriate. The role also includes processing rebills, applying system discounts, and meticulously documenting all communications in the host system. A key aspect of the job is prioritizing and resolving assigned inventory efficiently, meeting quality and productivity metrics, and maintaining proficiency in the host system. Additionally, the PAR II will review financial assistance applications for completeness, request missing documents while adhering to HIPAA, and process these applications according to age and consumer requests. This role emphasizes excellent customer service, timely resolution of payor issues, and strict compliance with all relevant policies and regulations.

Requirements

H.S. Diploma or Equivalent
2 Years Healthcare Revenue Cycle Accounts Receivable Experience, healthcare or related organization.
Computer skills required in advanced word processing, spreadsheets, and graphic skills.
Ability to organize and coordinate workflow as well as meeting deadlines.
Must possess excellent communication, problem solving documentation, training and customer service skills.
Must be familiar with organizing, managing workflow and ability to absorb and retain details.
General knowledge of medical and insurance terminology required.

Nice To Haves

Experience in Epic preferred

Responsibilities

Verify validity of account balances by researching, reviewing, and ensuring accuracy of payment and adjustment posting.
Take initiative to resolve accounts with and without supervision.
Contact payors, networks, patients, employers, and other responsible parties to acquire timely and accurate/expected payment on assigned Accounts Receivable inventory.
Take necessary steps needed to acquire and provide information needed for claims that have a zero payment.
Use payor-specific contract terms to resolve claims that are in process or have a payment variance.
Refer claims that have a clinical denial to the Denials team for review and follow-up.
Prepare appeal letters to dispute payor denials when appropriate.
Process &/or request rebills and other system actions, as needed.
Understand and apply appropriate system discounts.
Enter all communications regarding patient accounts in the host system.
Work accounts daily, with an emphasis on quality and resolution.
Stratify worklists to ensure high dollar and/or aged accounts are the top priority, with the overall goal of resolving assigned inventory each week.
Work toward department goals and visions as an individual and as a team player.
Meet, and maintain, quality and productivity performance metrics set forth by applicable leadership.
Maintain proficiency in the host system.
Review financial assistance application for completion prior to processing.
Determine if financial assistance application is complete.
If incomplete, request additional documents from consumer by phone, mail, or email following HIPAA privacy guidelines.
Document receipt of financial assistance application in system and create a Case in Financial Assistance Module.
Use appropriate activity code in Epic to ensure productivity is accurate.
Review incoming financial assistance applications received by mail, email or MyChart, to determine if all the required information was submitted.
If incomplete, request additional documents from consumer by phone, mail, or email following federal HIPAA regulations.
Process financial assistance accounts timely, according to age, and consumer request.
Prepare and mail all financial assistance approval/denial letters.
Prepare documents for scanning, remove non-essential information from packets to protect consumers financial information.
Provide excellent service when dealing with payors, patients, employers, management, hospital staff and other parties within and outside of THR.
Ensure communication is clear, concise, and professional.
Address requests timely, with the goal of completion within 3 days to avoid delinquency.
Give escalated requests immediate attention.
Identify and resolve problems related to payor contracts and reimbursement in a timely manner.
Inform Business Operations Supervisor, Manager and/or Payor Champion of any potential trends that might delay accurate payment (via appropriate mechanism - spreadsheet, email, etc...).
Recommend accounts for placement with an outside collection/legal vendor when appropriate resolution is not obtained timely.
Ensure compliance with THR policies and procedures.
Comply with all applicable regulations with the operating systems, entity, and system policies and procedures.
Complete assigned tasks in a timely and effective manner.
Maintain up-to-date knowledge of local, state, and federal guidelines for communication and collections.