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Job Title: | Patient Account Representative | Reports To: | Revenue Cycle Director |
Department: | Patient Financial Services | FLSA Status: | |
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Prepared Date: | 01/24/2022 |
Summary: This position is responsible for working on a team to ensure accurate and timely submission of medical claims for patient services to third party payers; follow up on billing; processing denials and appeals: and providing excellent customer service.
Job Responsibilities:
- Process patient accounts and ensure accurate and timely submission of claims to third party payers. This includes paper and electronic claims.
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- Follow up on pending account claims and working ATB/Queues to maintain A/R goals set forth by CMC.
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- Interact with third party payers professionally to resolve questions, disputes, and process claims.
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- Follow up on current denials and submitting appeals timely and appropriately.
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- Submitting account adjustments and refunds as needed within the policies of CMC.
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- Provides excellent customer service; answering patients’ account inquiries; answering and returning patient phone calls; taking patient payments over the phone.
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- Works with patient accounting and PFS team as well as other departments as needed to resolve accounts.
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- Use of copy, fax, and credit card machine
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- Organizing and filing data
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- Use of computer programs such as Word, Excel, etc.
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Competencies:To perform the job successfully, an individual should demonstrate the following competencies:
- Problem solving: Identify and resolve problems in a timely manner; uses reason even when dealing with emotional topics; work in group problem solving situations.
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- Analytical: Ability to collect and research data; uses intuition and experience to complement data.
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- Oral communication: Speaks clearly and persuasively in a positive or negative situation; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.
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- Written Communication: Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.
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- Interpersonal: Focuses on solving conflict, not blaming; Listens to others without interrupting; Keeps emotions under control; Remains open to other’s ideas and tries new things.
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- Ethics - Treats all people with respect; keeps commitments; inspires the trust of others; works with integrity; upholds organizational values; maintains the confidentiality of all client/co-worker/organizational business.
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- Customer Service- Responds promptly to customer needs; Solicits customer feedback to improve service; consistently exhibits excellent phone skills; Responds to requests for service and assistance; Meets commitments
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- Team Work - Balances team and individual responsibilities; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Supports everyone's efforts to succeed.
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- Professionalism - Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments; represents the business in all actions, dress and conduct in accordance with the Mission and Vision.
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- 10. Attendance/Punctuality – Reports to work at designated start time, assures work responsibilities are covered when absent; gives appropriate notification for absences.
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- Dependability - Takes responsibility for own actions; Keeps commitments; Completes tasks on time or notifies appropriate person with an alternate plan.
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- Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.
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Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience: High School diploma or equivalent preferred. Previous billing or collections experience preferred.
Certificates and Licenses: Certified patient account representative, or willing to achieve certification within 1 year of hire.
Language Ability: Speak, write and understand English
Math Ability: Must have intermediate math skills which include the ability to calculate figures and amounts such as percentages, discounts, interest, proportions, area, and volume: ability to apply basic algebra and geometry
Interpersonal Skills: positive attitude, listen actively, pay attention, resolve conflict, critical thinking skills, adapt to changing processes, and contribute to problem solving
Computer/Technical Skills: This job requires regular use of computer, calculator, phone, copy and fax machine
Work Environment:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Specific Work Environment Characteristics include: Low risk for bloodborne pathogen exposure. Office setting in a basement location with daily use of stairs.
Physical Abilities:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee must:
Sitting: This job requires that employee must be able to sit for extended periods of time, > 75%
Walking: Job requires walking indoors and outdoors, up and down stairs, <25%
Lifting: Job requires employees must be able to lift > 20#
Carrying: Job requires employee to carry objects in his/her arms or on shoulders, <25%
Grasping: Job requires employee to regularly pick up objects with fingers, >75%
Reaching: Job requires employee to use hands and arms to reach for objects
Speaking: Job requires expressing ideas by the spoken word >75%
Listening: Job requires the perception of speech or other sounds
Reading: Job requires ability to read and comprehend patient accounts and written instructions
I acknowledge, understand and agree to the job duties and requirements for this position.
I understand that I may be assigned other duties, in addition to or in place of those described previously. I also understand that the essential duties of this position may change at any time, according to the needs of Coulee Medical Center.
I further understand that my employment is at-will, and therefore understand that my employment may be terminated at-will by Coulee Medical Center or myself.
Employee Name (printed): | ______________________________________________ |
Employee Signature: | ______________________________________________ |
Date: | _____________________________________________ |