Patient Account Representative to Outpatient

Hospital for Special Care•New Britain, CT

11d•$22 - $32•Onsite

About The Position

The Patient Account Representative is responsible for accurate billing and timely preparation and submission of claims for assigned outpatient accounts. The role analyzes accounts to assess collectability and applies appropriate collection, adjustment, or write-off procedures. It collaborates with outpatient clinical departments to resolve account issues, reports inconsistencies and trends to management, and handles customer service calls from patients, patients’ families, attorneys, and other professionals. The position is based at Hospital for Special Care in Patient Financial Services and is scheduled for 40 hours per week on first shift. The representative follows up on assigned accounts, uses accounts receivable reports and worklists to prioritize balances over 90 days, documents account activity, reviews payment and collectability variances, follows up on denials, and coordinates appeals with clinical leadership. The role also supports claim submission coverage when needed, reviews account collectability quarterly, resolves credit balances, assists with audits and targeted projects, and works with colleagues and clinical staff to address account concerns. The position involves frequent computer and telephone use, frequent walking, standing, sitting, lifting/carrying and pushing/pulling up to 20 pounds, and other physical activities including bending, squatting, balancing, reaching, and twisting. The work may occur in a crowded, noisy environment with moderate noise and frequent interruptions. Occasional overtime may be required, and work hours or schedules may be adjusted to meet changing departmental priorities.

Requirements

Bachelor’s degree required; commensurate experience will be considered.
Knowledge of third-party collections and reimbursement.
Two years of hospital or medical business office experience, or comparable experience with a third-party or collection agency.
Excellent verbal, communication, organizational, interpersonal, and analytical skills.
Experience with healthcare financial systems and Microsoft Word, Excel, and Outlook.
Ability to exercise independent judgment and problem-solving skills, communicate in writing and verbally, comprehend written and auditory information, and perform computations.
Ability to manage multiple responsibilities, initiate work independently, access resources, adjust to changing priorities, and meet deadlines.
Ability to lift, carry, push, and pull up to 20 pounds frequently.
Ability to use a computer and telephone for extended periods and perform frequent physical activities including walking, standing, sitting, bending, squatting, balancing, reaching above shoulder height, and twisting.
Ability to work with moderate noise and frequent interruptions and to work independently and as part of a team.
Availability for occasional overtime as needed.

Nice To Haves

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

Responsibilities

Ensure accurate billing and timely preparation and submission of claims for assigned accounts.
Analyze accounts for collectability and apply appropriate collection, adjustment, or write-off procedures.
Collaborate with outpatient clinical departments to resolve account issues and report inconsistencies and trends to management.
Handle incoming customer service calls from patients, patients’ families, attorneys, and other professionals.
Maintain understanding of third-party coverage, reimbursement, hospital contracts, and relevant procedures and guidelines.
Review potential risk applications with the Team Lead and/or Manager of Patient Accounts & Reimbursement, and keep the Team Lead apprised of unusual activity.
Communicate concerns relating to patient registrations through established departmental methods.
Report outstanding unworked account concerns to the Manager of Patient Accounts & Reimbursement after three weeks.
Understand claim submission processes and provide coverage for the Claims Analyst when necessary, including mailing paper claims and submitting secondary claims manually or electronically.
Follow up on assigned accounts promptly and initiate collection procedures as required by policy.
Use accounts receivable reports and worklists to prioritize collection efforts on balances over 90 days.
Document account efforts in the hospital accounts receivable system.
Use hospital contracts and reimbursement policies to support appropriate account adjudication and understand contractual allowances and their effects on accounts receivable.
Review payment, collectability, or similar reports to identify contractual or payment variances; analyze variances and complete appropriate rebilling or adjustments.
Maintain working knowledge of the accounts receivable system, use it effectively, and notify management of functionality issues affecting workflow.
Review accounts quarterly for potential collectability, recommend reserve adjustments when appropriate, and continually analyze and resolve credit balances.
Follow up on adjudicated denials and coordinate appeals with clinical department leadership, documenting efforts in the hospital accounts receivable system.
Collaborate with the OP Authorization and Charge Capture Specialist to ensure timely appeal submissions.
Collaborate daily with other Patient Account Representatives and provide support as needed.
Participate in case concerns with clinical staff when requested.
Compile documentation for year-end, payer, and internal audits as requested.
Assist management with targeted projects as needed.
Adjust work schedule to changing priorities and work independently as well as collaboratively.
Work occasional overtime on an as-needed basis.