PATIENT ACCOUNTS REPRESENTATIVE II – BUSINESS SERVICES

Lewes, Delaware,     Summary: Responsible for the billing and follow-up activities for commercial claims. Position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing and collection of accounts while following departmental productivity and quality control measures that support the organization’s operational goals.   Other information: At least one year experience in Business Office practices with emphasis in billing duties. Must have good command and use of keyboard functions to use a CRT. Typing and computational skills are required. Must be familiar with medical terminology, ICD9/ICD10 and CPT coding.   Responsibilities: Analyzes and validates commercial correspondence and denials within 3 working days. Researches denial criteria and compares to payer contract and benefits for appropriateness. If assigned, handles the billing of secondary commercial claims, to include reviewing/correcting any incorrect or missing insurance information, sorting/preparing claims and remittances for submission, and demanding/working secondary claims that require a 30 day hold to payers. Reviews account receivable files and examines accounts to ascertain previous billing and collection actions, status of pending insurance coverage and delinquent payments.

Contacts insurance carriers and/or customer by telephone or mail to secure payment in the shortest possible time. Rebills insurance when necessary. Records collection action taken on accounts. Maintains responsibility of account until paid in full. Recognizes and reports payer denial trends and issues to leads and makes recommendations for changes to reduce or eliminate denials. Works to improve processes, increase accuracy, create efficiencies, and achieve the overall goals of Patient Business Services. Provides clear, concise, and timely documentation in the patient accounting computer system. Is adept at utilizing the Collector Workstation. Maintains records and follow-up files as required. Handles incoming telephone calls and correspondence from insurances in a courteous and professional manner.

Researches and analyzes account history and accurately responds to inquiries to resolve the account in a timely manner. Demonstrates proficiency with the following computer systems and applications: Patient Accounting, Microsoft Word/Excel, Document Imaging, Epremis Claim Editor, and RAS. Is proficient in navigating through payer web sites. Demonstrates a clear knowledge of the revenue cycle and how it impacts the accounts receivable. Understands department and hospital policy and procedures as it relates to daily job responsibilities. Is able to analyze and identify issues that impact processing and reports them as appropriate to assure resolution. Actively participates in staff training to increase understanding of specific payer requirements as well as general billing and follow-up processes.     Competencies and skills: Essential:
* Clear Communication Skills Both Written And Verbal
* Knowledge Of Basic Computer Programs
* Able To Keep Confidential Information Regarding Patients, Team Members
* Able To Withstand Crisis Situations
* Has Skills To Provides Customer Service To Patients, Team Members And Visitors   Education: Essential:
* High school graduate or equivalent        L ocation: Hospital-Main Campus   Shift : 8am-4:30pm Monday – Friday   FTE: 1. 000000     Work Status: Full Time                

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