Job Description

Representative, Patient Accounts

Laguna Hills · Revenue Cycle Management
Laguna Hills , CA
Finance/Insurance/Reimbursement
Full Time, Days
Weekly Schedule: Monday-Friday
Bilingual: Preferred
Bilingual Type: English/Spanish
Posted 06/23/2021
Req # 6467

PRIMARY FUNCTION:  Patient Account Representative is responsible for managing and monitoring all tasks and communication related to the intake of information from guarantors and/or delinquent accounts to solicit payment. Other duties include: keeping records of collections and status of accounts, and taking incoming and make outbound calls to assist with patient account balances.
REPORTS TO: Reports to the Billing Manager
SUPERVISORY RESPONSIBILTIES: None
FLSA STATUS: Non-Exempt
EXEMPTION CLASSIFICATION: None
NAICS WORKERS COMP: Administrative Support Workers
EEO: Administrative Support Workers
PAY GRADE: Grade 4 Hourly

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

1.    Monitor queue to ensure calls are being handled professionally and appropriately.

2.    Perform analysis, research, and making decisions to appropriately handle phone inquiries.

3.    Review accounts and responsible for completing adjustments to ensure correct reimbursement as instructed by Manager.

4.    Identify delinquent accounts, aging period, payment sources, and correct any claim processing (data entry, verification, coding and/or posting) errors identified.

5.    Manage requests for medical records, correspondence, and/or Explanation of Benefits (EOB). Research proper processing and/or payment of accounts from patients with or without insurance.

6.    Responsible for collection efforts and for taking the appropriate steps to have claims processed for payment (i.e. re-submitting claims or filing claims appeal for payment or additional payment).

7.    Keeps Manager abreast of any changes, and documents any problems related to work methodology procedural and recommends actions.

8.    Identify and resolve patient billing disputes by evaluating patients’ financial status, establishing budget payment plans, collecting payments, and refunding patient credits. 

9.    Demonstrate good judgement and reads and abides by the company’s code of conduct, ethics, employee handbook, policies and procedures and other corporate mandates.

10.     Accountable for limiting the use and disclosure of Protected Health 
 Information (PHI) for patients and employees information to the Minimum  
 Necessary in order to perform job.

11.    Other various duties as assigned, including cross training in other functional areas.
*Non patient-facing
    
PERFORMANCE REQUIREMENTS:

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.

TYPICAL WORKING CONDITIONS: 
Indoor Work
Operating Computer
Reach Outward
Manual Dexterity
Lift/Carry 10 lbs. or less
Sitting

Other Physical Requirements:
Vision
Sense of Sound
Sense of Touch

EDUCATION: High School Diploma or equivalent required.

LICENSURE/CERTIFICATION: None

EXPERIENCE: Minimum 1 year of customer service experience in a healthcare setting required.

KNOWLEDGE, SKILLS & ABILITIES: 
*     Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.) Skill in defining problems, interpreting billing information. 
*     Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics. 
*     Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner. 
*     Must have strong verbal, written, and interpersonal communication skills 
*     Demonstrates ability to work well in a team environment. 
*     General PC knowledge including Microsoft Office, Internet and Email.
 

Application Instructions

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