Patient Account Representative to Outpatient

Hospital for Special Care•New Britain, CT

29d•Onsite

About The Position

Responsible for the accurate billing, timely preparation and claim submission of assigned accounts. Performs regular analysis of accounts to determine collectability and implements appropriate collection, adjustment, or write off procedures to settle accounts. Collaborates with outpatient clinical departments to resolve account issues. Reports inconsistencies and trends to management. Accepts incoming customer service calls from Patients, Patients Families, Attorneys and other professionals.

Requirements

Bachelor’s Degree required, commensurate experience will be considered.
Knowledge of third party collections and reimbursement.
Two years hospital or medical business office experience, or comparable experience with third party or collection agency.
Excellent verbal, communication, organizational, interpersonal and analytical skills.
Experience with healthcare financial systems and Microsoft Word, Excel & Outlook is required.
Ability to manage multiple projects and priorities while meeting deadlines preferred.

Nice To Haves

Familiarity with medical terminology preferred.
Ability to manage multiple projects and priorities while meeting deadlines preferred.

Responsibilities

Demonstrates a thorough understanding of third party coverage and reimbursement for accurate billing and payment.
Maintains working knowledge of all hospital contracts and their relevant procedures and guidelines.
Reviews potential risk applications with Team Lead and/or Manager of Patient Accounts & Reimbursement.
Keeps Team Lead apprised of unusual activity on a daily basis.
Communicate any concerns relating to patient registrations via the established methods by department (ie. shared file, email, etc).
Report to Manager od Patient Accounts & Reimbursement on any outstanding unworked account concerns after 3 weeks.
Daily claim edit review & submission is the responsibility of the Claims Analyst.
Responsible for understanding the process of claim submission and maintaining the ability to cover for the Claims Analyst if necessary. Coverage includes, mailing paper claims and submitting secondary claims (manual and electronic).
Responsible for timely follow-up on assigned accounts and initiation of appropriate collection procedures as required and as defined by policy.
Demonstrates a thorough understanding of hospital account receivables.
Uses the A/R reports and worklists to place collection emphasis on balances over 90 days.
Concisely document all efforts in hospital accounts receivable system.
Utilize hospital contracts and reimbursement policies to ensure appropriate adjudication of accounts.
Demonstrates a strong understanding of system contractual allowances and impact on accounts receivable.
Review account activity through the use of payment report, collectability report or similar reports to identify contractual or payment variances.
Analyzes identified variances and implements appropriate rebilling and/or adjustments accurately and efficiently.
Maintains appropriate working knowledge of the accounts receivable system, demonstrates effective usage that maintains accuracy of billing and increases timeliness.
Notifies management of any variations in system functionality that affect workflow.
Reviews accounts quarterly to report on the potential collectability of each.
Recommends additional reserve adjustments if appropriate.
Analyzes and resolves credit balances on a continual basis.
Follows up on adjudicated denials.
Coordinates appeals with clinical department leadership and documents all efforts in the hospital AR system.
Collaborates with the OP Authorization and Charge Capture Specialist to ensure appeals are submitted timely.
Expected to collaborate with other Patient Account Representatives on a daily basis and support one another when needed.
Participates in case concerns with clinical staff when requested.
Compiles documentation requested for year-end audit, payer audits, and internal audits as requested.
Assists management with targeted projects as needed.