[Hiring] Patient Account Representative 4 @FMOLHS

Role Description

The Patient Accounts Representative 4 performs an important function in the revenue cycle of the Health System. This role is production based and works an assigned queue to coordinate with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and professional charges. The Patient Accounts Representative is responsible for the customer service, billing and collection functions in the Business Office.

• Review accounts on EPIC system, providing information requested and applying critical thinking to resolve issues between balances and/or credits belonging to managed care vs the patient.
• Responsible for collections on delinquent insurance and patient balances.
• Work credit balance reports, post payments and adjustments, and file claims and appeals denials with managed care companies.
• Must meet minimum performance and quality measures.
• Leverages years of experience to handle more complex scenarios and provides SME support to other team members.
• Collaborates with leadership to identify opportunities for improvements.

Qualifications

• 8 years experience in Revenue Cycle / Hospital Business Office programs (Customer Service, Billing, Follow-up) or equivalent industry experience.
• Related certification program in areas such as billing, medical office, coding and accounting can be substituted for 1 year of experience.
• Bachelor's Degree can substitute for 4 years of experience; Associate's Degree can substitute for 2 years of experience.
• High School diploma or equivalent.
• Must possess knowledge of ICD-9/10, CPT and HCPCS coding.
• Apply critical thinking and problem solving skills as it relates to resolving accounts.
• Must understand the explanation of benefits of various managed care companies and regulations.
• Must be able to demonstrate teamwork and willingness to work in cooperation and support of others as well as comply with FMOLHS policies, procedures and core values.
• Communication, interpersonal and collaboration skills.

Requirements

• Execute Business Office Operations and Functions.
• Performs billing, collections, payment processing and/or customer service tasks according to documented process.
• Updates account with ownership and accountability of the entire account at that point in time.
• Leverages contract knowledge and expertise to drive revenue.
• Evaluates root cause and resolves issues on that specific account in a timely manner.
• Completes most transactional updates with one interaction.
• Identifies patterns, trends in account issues and escalates as appropriate.
• Maintains subject matter expertise on regulations, process and policies.
• Consistently meets production and quality requirements for area.
• Responds to requests (from customers, co-workers, management) in a timely and professional manner.

Benefits

• Assists with planning and participates in internal and external meetings as a representative of department.
• Serves as a subject matter expert to other team members.
• Provides training / shadowing support for new team members.
• Identifies areas for improvement or fixes to system edits / processes.
• Collaborates with Payor Relations and Vendors over contract issues.
• Creates & updates workflows to drive process improvements.
• Leads special projects / updates.