Patient Account Rep - Credit & Collection FT Days

Core Competencies

• Verifies patient’s insurance benefits from the payor, for services to be provided prior to the delivery of care.
  
  
• Transmits OASIS and HIS assessments in a timely manner through the QIES system while keeping errors below State mandated thresholds.
  
  
• Submits Notices of Election for Medicare Hospice Patients within the mandated time frame.
  
  
• Confirms all pre-bill edits have been cleared and all required signatures have been obtained prior to billing.
  
  
• Reviews bills prior to submission for payment for completeness and accuracy.
  
  
• Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient.
  
  
• Tracks and reports the status of claims denied and in the appeal process, including both payments and adjustments.
  
  
• Notifies Finance Manager and agency Administrator of any Medicare ADR’s.
  
  
• Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
  
  
• Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
  
  
• Reviews and reports on accounts outstanding beyond 60 from discharge or the end of episode.
  
  
• Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
  
  
• Submits over the counter payments to the Business Office staff for deposit to the medical center’s account.
  
  
• Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
  
  
• Reconciles daily deposits with the amounts posted to the agency’s accounts receivable system.
  
  
• Reconfirms insurance benefits periodically throughout the patient’s care and annually reconfirms benefits of all patients on service.
  
  
• Performs reconciliation of cash deposits to the Accounts Receivable trial balance on a monthly basis prior to submitting the Journal Entry for Month End Close.
  
  
• Prepares requests for refund for those accounts that have been paid more than allowable.
  
  
• Completes the Medicare quarterly Credit Balance Report and submits the trial balance and the supporting documentation for review and approval.
  
  
• Stays informed of updated insurance requirements and reimbursement practices.
  
  
• Assists with training of new staff members.
  
  
• Reviews utilization to ensure authorizations are obtained timely for those services that require prior authorization.
  
  
• Ensures all billings are audited prior to billing.
  
  
• Prepares ad hoc reports for the Director, Revenue Cycle, as needed.
  
  
• Participates in hospital performance improvement activities (kaizens, lean initiatives) when appropriate.
  
  
• Follows departmental downtime procedures during period of computer network interruption to support department staff.
  
  

Experience