Patient Accounts Representative organizes inpatient and outpatient claims for electronic or hard copy mail and forwards to appropriate third party payers. Reviews claims to make sure that payer specific billing requirements are met, follows-up on billing, determines and applies appropriate adjustments, answers inquiries, and updates accounts as necessary. Being a Patient Accounts Representative requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Patient Accounts Representative works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Patient Accounts Representative typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Coordinates all relevant data collection necessary to obtain proper reimbursement to the organization from individuals and third party payers. This includes billing and collection of accounts receivable, counseling of indigent patients and interpretation of third party regulations.
Responsibilities
• Provide effective daily supervision of the work unit. • Coordinate and control work flow. • Monitor productivity through various reports and through direct observation of staff. • Compile, maintain and submit various management reports. • Determine methods and direct resolution of problem accounts. • Maintain effective communication between the assigned unit and other units, departments and outside organizations. • Ensure that employees are kept up to date on issues affecting operations. • Interpret insurance policy provisions for claim adjudication. • Interpret and apply credit and collection laws and regulations to Patient Accounts activities. • Interpret and communicate to staff billing procedures contained in the Medicare Claims Processing Manual, UB-04 Billing Manual, and other billing manuals and contracts as required. • Recommend policy and procedure changes and implement such changes. • Make decisions and solve problems as they relate to the assigned area of responsibility. • Exceptional situations are referred to Accounts Receivable Manager • Maintain an ongoing professional relationship with other departments in order to accomplish daily objectives • Act as a liaison to CAMC subsidiaries as needed. • Reinforce employee understanding of work integration with other departments throughout the institution.
Knowledge, Skills & Abilities
1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.
Education
Associate degree in Business or related field w/ 2 years of experience in a hospital or business office environment with specific exposure to identified area of expertise.
6 - 12 months supervisory experience n a hospital business office environment.
Credentials
• No Certification, Competency or License Required
Work Schedule: Days
Status: Full Time Regular
Location: General Hospital
Location of Job: US:WV:Charleston