Patient Account Representative
Pulse Staffing has a contract account representative position available with a top hospital in the Medical Center available immediately.
Position is responsible for:
Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures
Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes.
Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Ensures that all accounts associated with that guarantor and payor relationship are resolved.
Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance.
Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager.
Refers problem accounts to Sr. Rep, Team Lead or Manager prior to accounts becoming 60 days old. Documents the issues in detail and refers to Sr. Rep, Team Lead or Manager with a recommendation of action needed. Provides continual follow-up.
Assists with special projects to ensure that collection, workqueue, and departmental goals are met.
Candidate must have a minimum of 2 years of Hospital follow up experience
Strong Collections Experience Required
Candidate must be able to maintain the department standards for Productivity and Quality. Quality is not something we can quantify with someone in an interview, but we require our team to meet productivity requirements of an average of 50 accounts per day
General knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations.
The knowledge of how managed care plans work and the requirements for insurance coverage and benefits.
Ability to communicate effectively both oral and written, good interpersonal skills; decision-making skills; professional courtesy; the ability to operate a PC and general office equipment.
Account Representatives must have a strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations.
Must be able to work a minimum of 50 accounts per day.
Experience in Denial Management
Assisting in the identification and insurance denials for:
Incorrect info from patient
Charge Entry error
Incorrect registration data
Referral and Pre-authorization errors
Lack of medical necessity
Bundled or Non-covered
Experience as an Appeals Coordinator
Follow up and Appeals for High Dollar and Aged accounts with higher risk
Assist in Communication with Managed Care Department or Coordination or appeals with payor representative
Complete special projects and working with internal and external partners that are preventing timely payments
Coordinate appeal letters with Clinical Care providers
Completion of documents to assist front end of Revenue Cycle related to medical updates or authorization requirements
Experience requirements: Must have 2 years of RECENT Hospital follow up experience
Education Requirements: Must have high school diploma or GED. Associates or Bachelor's degree preferred, but not required.