The Patient Account Representative - Collector is responsible for the timely and accurate collection of fees for medical services rendered, such as examinations, treatments and procedures, to patients, and government or private insurance carriers.   

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. 

1.    Contacts third-party payers and/or patients to facilitate timely payment of past due charges; arranges alternative settlement plans as needed.  Ensures necessary internal approvals on payment plan arrangements.

2.    Provides information to insurance carriers or patients regarding patient accounts.  Assists patients with billing problems.

3.    Communicates with Manager on difficult accounts to ensure appropriate approvals and follow-up is conducted.  Gives feedback on accounts to Manager on an ongoing basis to ensure physicians and administration is updated on AR trends and issues. 

4.    Reviews explanations of benefits from third party payers to determine if payment received complies with billing standards and/or provider contracts.

5.    Prepares and submits claim appeals to carriers for any incorrectly processed or denied claims.

6.    Reviews and resolves account credit balances and/or line-item credit balances.

7.    Identifies problem delinquencies and recommends appropriate course of action, such as referral to outside collection agency, legal action or write off.

8.    Attends seminars and professional association meetings; reads pertinent literature to maintain current knowledge of collection policies and procedures and related legislation.

9.    Meets monthly cash collections and A/R goals for assigned carriers.

10. Maintains confidentiality of all records and information which pertains to patients, physicians, employees, the organization and in related interests.

11. Displays courtesy and consideration to patients, guests, physicians and staff.  

12. Regular and consistent attendance.

ADDITIONAL FUNCTIONS:

1.    Assists in entering patient account data into computer system.

2.    Provides coverage for department telephone operator.

3.    Assists with payment posting, processing credit card payments, and preparing deposits.

4.    May act as backup for insurance verification, and patient registration duties.

5.    Perform special projects or other related work as required or requested.         

QUALIFICATION REQUIREMENTS: 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 and/or EXPERIENCE: Five to eight years of experience in medical billing and collections; knowledge of insurance and medical terminology, ICD-9, CPT, and HCPCS coding; understanding of federal and state laws governing medical billing compliance.  

LANGUAGE SKILLS: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals, ability to write routine correspondence.

MATHEMATICAL SKILLS: Basic ability to work with accounting concepts such as debts and credits.  Ability to apply concepts such as fractions and percentages to patient accounts.

REASONING ABILITY: Ability to apply commonsense understanding to carry out

instructions furnished in written, oral, or diagram form.

OTHER SKILLS and ABILITIES: Audit and analyze information related to claims denials.  Computer proficient in Microsoft Office products (e.g. Outlook, Word, and Excel), and medical billing software programs. Able to work in a fast-paced environment.

PHYSICAL DEMANDS: 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.

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. The noise level in the work environment is usually moderate.

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