Patient Account Representative

Gillette Children's•Saint Paul, MN

12h•Hybrid

About The Position

This position provides support for recovering back-end revenue by ensuring timely and accurate processing of patient accounts to both third party payors and patients/guarantors. Promotes and maintains professional and positive patient and family experience as the last impression of the organization. Additional responsibilities are defined as those specific duties relating to the various revenue cycle functions as assigned by the Revenue Cycle Practice Manager, Team Goals, and Organizational job performance standards.

Requirements

High School Diploma/ GED
1-3 years’ experience in customer service, administrative or healthcare setting
Knowledge & understanding of medical terminology
Knowledge & understanding of commercial insurance carriers and standard insurance forms
Strong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook)
Demonstrated strength in customer service, organization, attention to detail and the ability to work independently
Demonstrated ability to work and problem solve in a collaborative manner within the department and organization
Demonstrated ability to multi-task and respond quickly/reprioritize changing needs
Must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed.

Nice To Haves

Advanced education (Associate or Bachelors)
2+ years of medical billing or coding experience that includes exposure to payor
DME Billing Experience

Responsibilities

Resolving front end claim edits to ensure accurate and timely clean claim submission to third party payors for adjudication.
Following up on outstanding patient accounts to clarify reason or delayed and/or delinquent processing and resolving technical denials to ensure accurate and timely processing in order to reconcile outstanding balances.
Knowledge of commercial and government payor regulatory requirements, timely filing guidelines and payment methodology.
Knowledge of claim forms – UB04, HCFA 1500, etc.
Ability to research and resolve claim edits to release clean and timely claims for processing.
Provides feedback to analysts and/or leader when barriers arise in resolving claim edits preventing claims to release.
Meets and maintains quality and productivity metrics as well as Gillette CARES values as set by the department.
Knowledge of and ability to accurately read EOB’s.
Knowledge of CARC/RARC codes.
Demonstrates understanding and ability to apply patient account policies and procedures.
Follow up on claims submitted to payors for adjudication to ensure claim has been received and in process for payment or denial within 30-45 days of claim submission.
Follow up on delinquent accounts after 30 days of no response with payors by calling and/or utilizing payor portals for clarification on delays.
Files corrected claims when necessary using correct bill types/submission codes.
Works with peers and analysts as necessary to resolve claim issues.
Works with analysts and other departments to file claim appeals.
Processes hospital receivables in a timely and accurate manner.
Performs basic maintenance of patient accounts in EMR system as necessary.
Assessment of outstanding balances for assigned accounts to determine proper course of action for obtaining payment and reconciling balance.
Demonstrates competency in organizational systems including: Cerner Revenue Cycle, Change Healthcare, eDOCS, online resources and other relevant technology.
Adheres to all organization and department policies, guidelines, and workflows to eliminate errors in practice.
Adheres to organization and department attendance policy.
Independently completes annual training as assigned.
Completes self-assessment timely and with contributing comments.
Completes 80% of peer feedback for direct peers.