Patient Account Representative RBO

East Tennessee Children's Hospital

1d•Onsite

About The Position

This position is responsible for the accurate billing and collections of Physician Receivables. The role involves providing feedback to the team lead to improve daily processes and collections, working collaboratively in a team environment, and problem-solving. Key functions include ensuring clean claims and timely follow-up with insurance companies. The position reports to the RBO Lead Patient Account Representative. At Dolly Parton Children’s Hospital, the organization emphasizes core values of Compassion, Ownership, Respect, and Excellence, fostering a culture of team engagement and aiming to provide extraordinary and meaningful experiences to patients, families, team members, and the community.

Requirements

High School Diploma/GED
Excellent customer services skills and ability to work with a team
Familiar with rules and regulations of CMS/Tenncare and other payers to ensure proper collection of insurance data to finalize claims for proper billing and to proper payer on first claim submission
Excellent typing skills
Ability to work with insurance companies to ensure timely payment of claims
Problem solving skills and multi tasking

Nice To Haves

Physician billing and collection experience

Responsibilities

Answers incoming telephone call in a courteous and helpful manner
Answers calls timely and ensures families receive a response within 24 hours
Takes initiative on calls to settle disputes when possible
Ends conversations with families by asking “is there anything else I can do for you today"
Answers inquiries and requests; completes or refers calls to the appropriate contact
Relays complete, detailed messages and information to the appropriate individuals, while maintaining confidentiality of all information
Works collection desktop to ensure claims are processed in a time-sensitive manner to reduce/eliminate timely filing errors
Works with office manager to retrieve necessary information for complete claim processing
Processes claims for hold and collection status
Verifies and edits patient/subscriber information in computer system
Reviews procedure codes and diagnoses codes on rejected claims and assists office with corrections
Works all insurance rejections on the day they are received in a timely manner
Offers long term solutions for repeat issues
Appeals denials as needed
Communicates electronically with payer when possible to ensure proper audit trail to prove timely and dispute any improper response with account representative etc.
Documents accounts properly
Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment
Interacts with all patients and staff in a considerate and helpful manner
Maintains professional composure and confidence during stressful situations
Maintains confidentiality of all hospital and patient information at all times
Does not discuss any patient information in public areas
Does not discuss any patient with friends or family who may call to ask about a child who has been here
Only discusses patient accounts after HIPAA information has been verified in system
Only accesses accounts needed to complete resolution of the account
Cannot access friends’ or family’s accounts
Refers any accounts that should not be accessed by self (e.g., friends, family, in-laws) to the team leader, neighbor, etc. for reassignment
Continuously displays a “can do” attitude within the practice and across other departments to contribute to the overall focus on service excellence
Completes all Children’s Hospital and practice required training and CBL requirements
Attends all educational programs as needed
Maintains a safe and clean work area
Practices safe lifting and body mechanics
Willingly accepts any other assignment that may be requested
Utilizes hospital resources and time respectfully and accountably
Works as efficiently as possible to ensure best use of time