Patient Account Representative

Prime Healthcare•Ontario, CA

10d

About The Position

The Patient Account Rep I posts incoming payments to the correct patient accounts daily, inputs and retrieves data from computer systems, reconciles accounts, and applies payments accurately and efficiently. The role distributes billing to appropriate personnel and reviews and follows up on authorizations and specialty referrals. It maintains current knowledge of contracts and state Workers’ Compensation fee schedules and handles incoming and outgoing hospital mail, correcting mailing errors promptly. The representative uses tact and discretion when handling inquiries from patients and families. The role performs timely payment analysis of managed care contracts to determine whether appropriate reimbursement has been received. It analyzes insurance payments using applicable regulations, guidelines, and systems to maximize and ensure correct reimbursement of hospital receivables. The representative works with payers and internal resources to identify and resolve payment issues, applies California and federal regulations to payment practices, applies contractual adjustments to patient accounts as needed, and forwards underpayments and denials to appropriate departments for follow-up and further revenue collection.

Requirements

Ability to multitask and prioritize needs to meet required timelines.
Analytical, mathematical, and problem-solving skills.
Customer service experience.
Effective written and verbal communication skills.
High school graduate or GED equivalent required.
Knowledge and basic understanding of medical coding and third-party operating procedures and practices.
Knowledge of multiple insurance billing requirements and 6 months to 1 year of billing experience required.
Medical and insurance terminology essential.

Nice To Haves

Experience in accounts payable, accounts receivable, or cashier work preferred.
Familiarity with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology preferred.

Responsibilities

Post incoming payments to the correct patient accounts daily.
Input and retrieve data from computer systems and reconcile accounts daily.
Apply payments accurately and efficiently and apply contractual adjustments to patient accounts as needed.
Distribute billing to appropriate personnel.
Review and follow up on authorizations and specialty referrals.
Maintain current knowledge of contracts and state Workers’ Compensation fee schedules.
Handle incoming and outgoing hospital mail and promptly recognize and correct mailing errors.
Handle inquiries from patients and families with tact and discretion.
Analyze managed care contract payments and insurance payments for accurate and timely reimbursement of hospital receivables.
Work with payers and internal resources to identify and resolve issues that hinder accurate account payment.
Apply appropriate California and federal regulations to payment practices.
Forward underpayments and denials to appropriate departments for follow-up and further revenue collection.