PATIENT ACCOUNTS REPRESENTATIVE PER DIEM

Edit failed claims in the Claims Administrator system and correct data,

revising claim to a passed status for submission to payor for Primary,

Secondary, Tertiary, etc. Where required, create multiple claims. If error was

due to incorrect information on Paragon, then have revisions made to Paragon

and then re-bill account. Alert department responsible for error to avoid errors

in future.

Review delinquent error reports, Unbilled Aged Trial Balances to identify

reasons claims are held from billing. Satisfy those related to the Billing office.

Communicate with the front end departments, i.e. : Patient Access, Ancillary

Departments, and Medical Records for edits related to the respective area.

Monitor all related Paragon reports to identify claims requiring combination,

sequential or interim billing.

Monitor Late Charge reports daily for rebilling.

Medicare Behavioral Health Inpatients review available benefits to

determine interim billing period.

Charity Care validate eligibility for service period. Ensure billing data is

accurate for recurring account claims.

Review Claims Administrator Reports daily, to monitor the following :

Claims Imported

Claims Failed

Claims Not Imported

Edit Statistics (Reasons claims failed)

Prepare and perform follow-up for special and client billing for various payors.

Monitor responses from clearinghouse and payors to identify returned claims.

Adjust claims accordingly, for resubmission to the payor.

Review Aged Trial Balances for claims in billed status not yet paid. Perform

follow-up actions where required.

Manage receivables by exception. Follow-up on those not paid in accordance

with expected reimbursement. Contact payor to discuss payment variances,

submit adjustments where necessary. Prepare technical appeals where

required. Refer accounts for clinical appeal where required.

Analyze, identify and report areas of high volume error, for enhanced

automation opportunity in Paragon or Claims Administrator, or corrective

actions in front end areas.

Daily monitor and working of tickler system in Receivables Administrator to

include the following :

Work ticklers generated by system based on path assignments.

Work ticklers assigned by Claims Management, Management Team

and Self Pay teams for payor updates.

Monitor follow-up on all accounts

Utilize Horizon Patient Folder to monitor and follow-up on hardcopy

correspondence. Mitor and process all requests for Medical Record

documentation.

Monitor claims in Medicare FSS.

Maintains established departmental policies and procedures, objectives,

quality assurance program, safety, environmental, and infection control

standards. Promotes adherence to the Patient’s Bill of Rights.

Understands and adheres to departmental policies and procedures.

Adheres to the Medical Center’s Code of Conduct.

Familiar with the Medical Center’s Mission, Vision and Value statements.

Maintains established departmental policies and procedures, objectives,

quality assurance program, safety, environmental, and infection control

standards.

Customer Service : respect, flexibility, knowledge, confidence, professionalism,

pleasant attitude, patience and helpfulness. All responses should be timely,

professional, caring, and respectful in accordance with Customer Service

Performance expectations.

OTHER JOB DUTIES

Performs other related duties as required.

Attends required meetings

Assists in training of new and established employees

Performs other related duties as required

BASIC COMPETENCIES

Education :

High school graduation or equivalent required.

Experience :

Minimum of 1 year experience in medical billing procedures, with familiarity with third party

insurer regulations required.

Skills :

Typing : 25 WPM (tested)

Must pass alphanumeric skills test

Intermediate level computer skills required, to include Excel and Word.

Computerized billing knowledge essential

Good Oral and Written communication skills

Good interpersonal skills

Speaks, reads and writes English to the extent required by the position.

Ability to plan and utilize time management skills.

Computer literate.

Good organizational skills.