Job Description

This position primarily involves following up on accounts for services rendered at Williamson Health. This is to maximize the full payment potential of each claim from the Commercial, Government and Auto Liability carriers in a timely and accurate manner. The Patient Account Rep serves as a liaison between the patients and insurance carriers. The PAR works with all departments in the hospital to ensure the proper charges, adjustments and codes are processed by the carriers and the patient’s balance is correct. This position also serves as a fill in for the Commercial/Government Biller whenever needed.

POSITION REQUIREMENTS

Formal Education / Training:
Must be a high school graduate or equivalent, have hospital and physician billing experience, have PC and calculator experience, and have good communication skills to discuss account financials with insurance carriers and patients.

Workplace Experience:
Prior experience in a hospital setting or related area is required. Working knowledge of DDE and EServices strongly preferred. Home Health, Hospice and SNF follow-up experience preferred, but not required.

Equipment and Skills Training:
Meditech System, SSI Electronic Billing System, SSI Electronic System for RA Print, FIND IT, Experian, Blue Cross, DDE System, Payer Websites, Excel, Word, PC, Printers, Fax, Copier

Physical Environment:
Business Office

Physical Effort:
Requires sitting for prolonged periods of time, viewing the computer screen and using repetitive motions, and must have a clear, understandable telephone voice

PERFORMANCE STANDARDS

1. Utilizes SSI Electronic software (when necessary) to accurately process all Medicare and Medicare Managed Care accounts assigned by system daily
2. Processes Medicare and Medicare Managed Care paper claims when necessary
3. Compares SSI electronic claim against Meditech claim when dealing with Medicare questions regarding claim submitted and works on resolving discrepancies to prevent denial.
4. Utilizes Medicare’s Direct Data Entry (DDE) system to access information such as claim status inquiry, eligibility, daily Medicare check amounts, etc.
5. Analyzes Medicare EOBs and remittances for secondary insurance filing and to determine appropriate patient liability or secondary payer amount
6. Utilizes Outlook to communicate denials with the various departments as well as Passport and Medicare Managed Care websites for information necessary for account processing.
7. Completes review of assigned Medicare accounts utilizing ATB (current account balance) reports and/or Collector Desktop list as needed for account processing in a time frame that is consistent with peers.
8. Converses and documents all discussions with Medicare and Medicare Managed Care payers regarding unpaid claims
9. Answers patient calls regarding billing and account balances for all Medicare/MCR Managed Care accounts
10. Re-queues Medicare/MCR Managed Care claim forms and itemized bills as needed after audit corrections have been completed
11. Handles and prioritizes multiple tasks
12. Completes any other job duties assigned by the department Director or Supervisor(s)