Patient Accounts Representative
Company: Beth Israel Lahey Health
Location: Plymouth
Posted on: January 20, 2023
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Job Description:
When you join the growing BILH team, you're not just taking a
job, you're making a difference in people's lives.Job
Type:RegularScheduled Hours:40Work Shift:Day (United States of
America)8-hr shifts; Monday - FridayJob
Description:Duties/ResponsibilitiesUnder 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 RequiredAbility 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
preferredRegistration/CertificationSuccessfully 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.FLSA
Status:Non-ExemptAs a health care organization, we have a
responsibility to do everything in our power to care for and
protect our patients, our colleagues and our communities. Beth
Israel Lahey Health requires that all staff be vaccinated against
influenza (flu) and COVID-19 as a condition of employment. Learn
more about this requirement.More than 35,000 people working
together. Nurses, doctors, technicians, therapists, researchers,
teachers and more, making a difference in patients' lives. Your
skill and compassion can make us even stronger.Equal Opportunity
Employer/Veterans/Disabled
Keywords: Beth Israel Lahey Health, Plymouth , Patient Accounts Representative, Other , Plymouth, Massachusetts
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