Patient Account Representative

Job Description

Job Description

Contributes to the Division of Clinical Operations' financial success by reviewing and processing claims during various stages of the revenue cycle in a timely and compliant manner to achieve the highest reimbursement.

As well as confirming that, all operational service commitments are met for assigned responsibilities.

Essential Job Functions :

1. Responds to inquiries and resolves discrepancies involving moderately complex financial transactions

in a timely manner, requiring a general understanding of work-area policies and procedures.

2. Reviews, follows up, and appeals for aged insurance balance accounts to ensure timely revenue collection through use of EDI clearinghouse, payer portals, worklog and reports for NextGen and / or Axium.

3..Reviews and processes delinquent unpaid accounts by patients accounts eligible for collections.

4. Processes referrals or authorizations as required by payers.

5. Processes claims for multiple payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.).

6. Ensures assigned claims meet clearinghouse and / or payer processing criteria.

7. Ensures appropriate follow-up on assigned work lists.

8. Ensures work meets departmental productivity and quality review standards.

9. Communicates issues regarding claims follow-up process and potential resolutions.

10. Works with payer response reports and rejection reports to meet Departmental Productivity and Quality Review Standards.

11. Complies with federal, state, and company policies, procedures, and regulations.

12. Operates computers programmed with accounting software to record, store, and analyze information.

13. Operates 10-key calculators, typewriters, and copy machines to perform calculations and produce documents.

14. Debits, credits, and totals accounts on computer spreadsheets and databases, using specialized accounting software.

15. Checks figures, postings, and documents for correct entry, mathematical accuracy, and proper codes.

16. Reconciles or notes and reports discrepancies found in records.

17. Resolves discrepancies in accounting records.

18. Accesses computerized financial information to answer general questions as well as those related to specific accounts.

19. Generates reports to ensure timely information is available for management use.

20. Complies with federal, state, and company policies, procedures, and regulations.

21. Completes special projects as assigned.

22. Performs other duties as assigned or required.

Marginal Job Functions :

Knowledge :

1. General knowledge of MS Office Suite (Outlook, Word and Excel).

2. Clerical - General knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms, and other office procedures and terminology.

3. English Language - General knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

4. Customer and Personal Service - General knowledge of principles and processes for providing customer and personal services.

This includes needs assessment, meeting quality standards for services, and evaluation of user satisfaction.

Skills :

1. Active Listening - Proficient skills in giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

2. Reading Comprehension - Proficient understanding of written sentences and paragraphs in work related documents.

3. Speaking - Proficient skills in talking to others to convey information effectively.

4. Critical Thinking - Basic skills in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

5. Mathematics - Basic skills in using mathematics to solve problems.