Patient Account Representative (Customer Service)

Phoebe Putney Health System•Albany, GA

1d•Onsite

About The Position

The Patient Account Representative processes and monitors billing and follow-up of claims submitted for payment to insurance payors, governmental payors, and state agencies. The role prepares and reviews claims, works failed claims according to carrier requirements, and communicates with patients, employers, and carriers to resolve claim issues. It also requires maintaining account documentation, preparing productivity reports, and following business office guidelines and payer regulations.

Requirements

High school diploma or GED.
2–3 years of experience in a structured business environment.
CPAR certification, or must obtain it within two years of employment.
Demonstrated knowledge of payer guidelines, regulations, programs, and office machines used.
Mastery of the computer programs and office machines used.
Ability to document required information clearly and accurately, tailoring documentation to its intended users and following required terminology, style, and format.

Nice To Haves

2–3 years of experience in a hospital, physician office, or insurance environment.

Responsibilities

Prepare billing and follow up on claims in a timely manner.
Review accounts and verify billing information before submitting claims to applicable payors or state agencies; enter or revise information as needed.
Prepare adjustment bills, rebills, reprinted claims, and other source documents.
Process failed claims in the biller work file according to carrier-specific requirements.
Coordinate with concurrent review precertification nurses and/or admitting staff regarding precertification requirements.
Prepare daily productivity reports.
Serve as a liaison between patients, employers, and carriers to resolve claim issues and communicate claim status.
Process patient inquiry requests within 24 hours and assist with customer service coverage as needed.
Maintain account notes for written and verbal correspondence with carriers, patients, and guarantors, and scan correspondence into the system.
Submit the Medicare Credit Balance Report quarterly.
Attend seminars and education related to Medicare, Medicaid, and commercial payors, and participate in hospital and departmental staff meetings.
Document and submit required information and data accurately and promptly, using appropriate terminology and required formats.
Follow hospital and departmental attendance, punctuality, policies, procedures, and core values; complete required education, in-services, and competency evaluations.
Maintain current knowledge in areas of responsibility and demonstrate age-specific customer service skills after training.
Wear protective clothing and equipment as appropriate.
Perform other duties as required.