Patient Accounts Representative
Company: Jordan Hospital
Location: Plymouth
Posted on: June 24, 2022
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Job Description:
Duties/Responsibilities
+ Under the supervision of the Assistant Director of Patient
Accounts, the Patient Account Representative performs a variety of
duties relating to review, analysis, billing, follow up, accounts
receivable, adjustments and finalizing of third-party and self-pay
accounts receivable.
+ Coordinates and schedules work responsibilities to ensure timely
and accurate billing and follow up to all written, telephone and
computer generated account inquiries.
+ Reviews, corrects and completes all patient and third-party
initial billing and corrected claims before submission to
third-party payers or patients. Initiates necessary patient
demographic, insurance, charge, and coding corrections needed in
working with necessary Departments to facilitate changes needed in
the system before generating claims to payers.
+ Ensures that billing time limit filing requirements are met
including providing necessary pertinent documentation as proof of
timely filing based on various third-party payer requirements.
+ Makes necessary corrections to various computer software systems
such as MEDITECH, proprietary electronic software provided by
third-party payers and other vendor electronic software.
+ Performs electronic transmission of claims to third-party payers
and performs necessary batch reconciliation review to ensure claims
were received by the third-party payer for processing.
+ Processes third-party payer and patient payments, adjustments and
denial information to patient accounts.
+ Batches and scans financial documents that need to be kept into
the optical imaging system for retrieval and audit purposes as
needed.
+ Generates patient statement mailers for self-pay and balances
after insurance.
+ Negotiates and establishes monthly budget payment plans with
patients for those who cannot pay in full upon receipt of first
billing statement in accordance with hospital credit & collection
policy.
+ Attend educational seminars and workshops regarding third-party
payer, state and federal program requirements.
+ Receive and respond to all incoming telephone inquiries from
third-party payers, patients, attorneys, physician offices and
other general public.
+ Responsible for cross-training to all phases of Patient Account
billing, cashiering and follow-up procedures.
+ Review third-party payer remittance advices to ensure proper
posting and payment.
+ Perform timely third-party follow up of unpaid claims by
telephone, electronic web based claim status inquiry, fax and
through written inquiries based on Department aged trial balance
and various third-party payer requirements.
+ Initiate third party and patient refund requests including
necessary supporting documentation for overpayments received by
third-party payers and/or patients.
+ Prepare written third-party payer appeals when technical payer
denials are received that require supporting documentation in order
to payer to reconsider denial for payment. Ensure that denials
requiring appeal are submitted within their established timely
filing limit based on specific payer requirements.
+ Review and recommend referral and write off of accounts to bad
debt when all hospital, state and federal criteria has been met
including minimum number of statements, date of first bill,
telephone calls, certified letters, etc. for audit proposes.
+ Knowledgeable of specific third-party payer requirements
regarding patient demographic, insurance and referral/authorization
requirements obtained during the patient registration/scheduling
process to ensure information obtained is complete and accurate to
minimize unnecessary payer denials.
+ Knowledgeable of ICD9, CPT, and Uniform Billing Revenue Coding
requirements specific to each payer as it relates to payment and
denial of services to initiate corrections needed to MEDITECH B/AR
module or by Health Information Services for resubmission of claims
for correct adjudication.
+ Basic knowledge of medical terminology as it pertains to billing
and coverage of services. Must be knowledgeable of specific payer
coverage limitations based on medical necessity guidelines and
patient waiver requirements.
+ Knowledgeable of hospital and HIPAA patient confidentiality and
privacy of patient health information policies and requirements as
it pertains to release of patient health information to patients,
payers, attorneys and other general public.
+ Knowledgeable of Free Care and other available financial
assistance programs to assist patients in applying and supplying
necessary verifications to determine eligibility.
+ Ensure that pre-payment or necessary financial arrangements have
been made prior to or at time of service for uninsured patients
having elective services in accordance with hospital=s credit &
collection policy.
It is understood that this is a summary of key job functions and
does not include every detail of the job that may reasonably be
required.
Education/Experience Required
+ Ability to use personal computer and computer system
software.
+ Effective oral and written communication skills are essential, as
staff must be able to interpret and explain patient accounting
information to patients, third-party payers and other general
public.
+ Ability to learn and apply procedural guidelines, time
utilization and solicit assistance when situations arise that
deviate from the norm.
+ High school diploma required.
+ Course in medical terminology preferred
Registration/Certification
+ Successfully complete a six-hour, educational program that
includes billing procedures, third-party payer requirements,
contracts, problem solving techniques and other relevant
materials.
+ Pass the open book competency test with a passing grade of 85 or
better.
Keywords: Jordan Hospital, Plymouth , Patient Accounts Representative, Other , Plymouth, Massachusetts
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