Patient Account Rep - Contract - Remote

Tenet Healthcare Corporation • United States,

3d • Remote

About The Position

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. The Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, and create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare, and Medicaid insurance is preferable. An effective revenue cycle process is achieved by working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance. The Representative must be able to work independently as well as work closely with management and the team to take appropriate steps to resolve an account.

Requirements

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Intermediate skill in Microsoft Office (Word, Excel).
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently.
• Ability to communicate in a clear and professional manner.
• Must have good oral and written skills.
• Strong interpersonal skills.
• Above average analytical and critical thinking skills.
• Ability to make sound decisions.
• Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors.
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.
• Minimum typing requirement of 45 wpm.

Nice To Haves

• Some college coursework in business administration or accounting preferred.

Responsibilities

• Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys, and team members as needed.
• Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions.
• Access payer websites and discern pertinent data to resolve accounts.
• Utilize all available job aids provided for appropriateness in Patient Accounting processes.
• Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account.
• Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
• Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies, or any other insurance collection opportunities.
• Provide support for team members that may be absent or backlogged.
• Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances by contacting third-party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends, and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identifies billing or coding issues and requests re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assists with special projects as assigned, documents findings, and communicates results.
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/problem aged accounts timely to Supervisor.
• Participate and attend meetings, training seminars, and in-services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

Benefits

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED