Patient Account Representative to Outpatient

Hospital for Special Care•New Britain, CT

10d•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 regularly analyzes accounts for collectability and carries out appropriate collection, adjustment, rebilling, or write-off procedures. It collaborates with outpatient clinical departments to resolve account issues, reports inconsistencies and trends to management, and responds to customer service calls from patients, patients’ families, attorneys, and other professionals. The position requires knowledge of third-party coverage, reimbursement, hospital contracts, accounts receivable, and contractual allowances. The representative follows up on accounts and denials, reviews payment and collectability information, resolves variances and credit balances, coordinates appeals, and documents account work. The role also supports audits, targeted projects, and team coverage as needed. This position is scheduled for 40 hours per week on the first shift. Occasional overtime may be needed. Work involves frequent computer and telephone use, frequent movement between positions and areas of the hospital, and work in an environment with moderate noise, interruptions, and sometimes crowded or noisy conditions.

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 work occasional overtime as needed.
Ability to work independently and as part of a team, adjust to changing priorities, initiate work independently, and manage multiple responsibilities.

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 carry out appropriate collection, adjustment, rebilling, or write-off procedures.
Collaborate with outpatient clinical departments to resolve account issues and report inconsistencies and trends to management.
Respond to incoming customer service calls from patients, patients’ families, attorneys, and other professionals.
Maintain knowledge of third-party coverage, reimbursement, hospital contracts, 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 patient registration concerns through established departmental methods and report outstanding unworked account concerns to the manager after three weeks.
Understand claim-submission processes and cover 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 according to policy.
Use accounts receivable reports and worklists to prioritize balances over 90 days and document collection efforts in the hospital accounts receivable system.
Use hospital contracts and reimbursement policies to support appropriate account adjudication.
Review account activity and identify contractual or payment variances; analyze and resolve them through appropriate rebilling or adjustments.
Maintain effective working knowledge and use of the accounts receivable system, and notify management about functionality issues that affect workflow.
Review accounts quarterly for potential collectability and recommend reserve adjustments when appropriate.
Analyze and resolve credit balances on an ongoing basis.
Follow up on adjudicated denials, coordinate appeals with clinical department leadership, and document efforts in the hospital accounts receivable system.
Collaborate with the OP Authorization and Charge Capture Specialist to ensure appeals are submitted on time.
Collaborate with other Patient Account Representatives and support colleagues 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.