VALLEY MEDICAL CENTER
JOB DESCRIPTION
The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.
TITLE: Patient Account Representative
JOB OVERVIEW: This position is responsible for performing a variety of complex duties in support of reimbursement from the patient liability and insurance carriers for both hospital and professional claim adjudication. As a Patient Account Representative, you will be a guiding force behind efficient patient billing and account management. Your responsibilities will span the entire account lifecycle - from processing claims and collecting payments to resolving issues and addressing patient inquiries with empathy and clarity. This position requires substantial knowledge and execution of third-party payer policies. Experience in patient liability management, collections, and communication proficiency is also required.
DEPARTMENT: Patient Financial Services
WORK HOURS: 8:00 am to 5:00 pm, Monday - Friday or assigned.
REPORTS TO: Manager, Patient Financial Services
PREREQUISITES:
Associate (2 year) degree required or equivalent experience, college (4 year) degree preferred.
Minimum three years of equivalent work experience in a hospital, medical office/clinic business office, or insurance company and experience with billing and collections, required.
Comprehensive working knowledge of third-party insurance processes, patient collection processing, complex remittance processing, and excellent customer service skills, required.
Demonstrated knowledge of medical terminology and abbreviations.
Demonstrated knowledge of Microsoft, Word, Excel, and Outlook.
Prior Epic Resolute Hospital and Professional experience preferred.
QUALIFICATIONS:
Excellent organizational and time management skills.
Excellent written and verbal communication skills.
Intermediate technical skills including PC and MS Outlook.
Advanced knowledge of Explanation of Benefits (EOB) for both the UB-04 for Hospital Billing and HCFA 1500 for Professional Billing.
Advanced knowledge of insurance billing, collections, and insurance terminology.
Extensive knowledge of third-party reimbursements from commercial insurance companies, government payers, and other third-party specialty payers.
Is flexible, adaptable, and can effectively cope with change.
Demonstrates effective communication and interpersonal skills with a diverse population.
Demonstrates the ability to communicate with tact, poise, courtesy, respect, and compassion.
Able to prioritize tasks, carry out assignments independently and within a team, and to practice good judgment.
Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations.
UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS:
See Generic Job Description for Administrative Partner.
PERFORMANCE RESPONSIBILITIES:
A. Generic Job Functions: See Generic Job Description for Administrative Partner
B. Essential Responsibilities and Competencies:
Maintains knowledge of payer requirements as a fundamental business practice responsibility under Valley Medical Center''s Corporate Compliance program.
Is familiar with VMC Patient Accounts payment policies and procedures including VMC financial assistance programs.
Demonstrates the awareness of the importance of cost containment for the department. Provide suggestions regarding process or quality improvement opportunities to department manager.
Requests Financial Assistance adjustments, administrative adjustments, and requests contractual allowance corrections per policy.
Works with patients regarding options for self-pay account balances, payment arrangements, and refers patients to financial counselor when appropriate.
Receive inbound and make outbound calls to respond to and resolve questions from patients, their families, insurance companies, attorneys, or any other entity or individual.
Responsible for accurate and timely billing of UB / HCFA claims for all insurance/government payors. To include primary, secondary, and tertiary billing.
Understands and adheres to all federal, state, and local payer-billing requirements.
Utilizes payer / provider instruction manuals and bulletins, hospital policy / procedures, and other resource materials to gain information to submit ";clean"; claims.
Reviews the payer rejections (837 transaction sets), UB and 1500 claim forms that have been rejected by the electronic billing system. Corrects errors and releases for transmission.
Reviews Explanation of Benefits (EOB''s) and vouchers, to pursue payment of claims.
Responsible for editing patient insurance information on accounts in accordance with the Insurance Carrier Change Policy and Procedure.
Contacts insurance company/ third parties, patients, physicians, and/or departmental staff to obtain necessary or missing information, and to collect outstanding payments.
Responsible to follow-up with the appropriate payer for claims status.
Identify, analyze, and resolve payment barriers.
Corrects data in payer systems such as Medicare and Medicaid
Research & resolve underpaid claims in collaboration with contracting department.
Research and appeal denied claims from payers to determine steps necessary to secure payment.
Take patient payments by phone or in person.
Explains policies and procedures to customers, solves problems independently and as part of a team.
Responsible for the daily reconciliation of cash to verify that it balances with the daily bank deposit.
Responsible for processing other department deposits within 24 hours of receipt.
Demonstrated knowledge of the current functionality of patient accounting systems
Coordinates non-compliant or disputed denials with Clinical Audit & Appeals Manager.
Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim.
Escalates problem accounts to Manager when appropriate intervention is required.
Performs all job functions in a manner consistent with Valley''s expectations as defined in Valley Values.
Works collaboratively and promotes an amicable working environment developing effective working relationships with key associates (HIM, Patient Access, Clinic Network, and Hospital Departments)
Maintains confidentiality of all protected health information.
Returns all phone calls within 24 hours of receipt of message.
Adheres to policies and procedures as required by VMC.
Participate in and attend meetings and training as required.
Regular and punctual attendance is a condition of employment.
Notify PFS Director and Manager when new insurance regulations are
identified.
Completes documentation of daily activities for individual productivity tracking and for patient account volume management.
Performs other related job duties as required.
Created: 1/25
FLSA: NE
Grade: OPEIUE
CC: 8531
Job Qualifications:
PREREQUISITES:
Associate (2 year) degree required or equivalent experience, college (4 year) degree preferred.
Minimum three years of equivalent work experience in a hospital, medical office/clinic business office, or insurance company and experience with billing and collections, required.
Comprehensive working knowledge of third-party insurance processes, patient collection processing, complex remittance processing, and excellent customer service skills, required.
Demonstrated knowledge of medical terminology and abbreviations.
Demonstrated knowledge of Microsoft, Word, Excel, and Outlook.
Prior Epic Resolute Hospital and Professional experience preferred.
QUALIFICATIONS:
Excellent organizational and time management skills.
Excellent written and verbal communication skills.
Intermediate technical skills including PC and MS Outlook.
Advanced knowledge of Explanation of Benefits (EOB) for both the UB-04 for Hospital Billing and HCFA 1500 for Professional Billing.
Advanced knowledge of insurance billing, collections, and insurance terminology.
Extensive knowledge of third-party reimbursements from commercial insurance companies, government payers, and other third-party specialty payers.
Is flexible, adaptable, and can effectively cope with change.
Demonstrates effective communication and interpersonal skills with a diverse population.
Demonstrates the ability to communicate with tact, poise, courtesy, respect, and compassion.
Able to prioritize tasks, carry out assignments independently and within a team, and to practice good judgment.
Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations.