PATIENT ACCOUNT REPRESENTATIVE- CBO- FULL-TIME

Summary

Processes unpaid accounts by contacting patients and third party payers. Assists patients with questions on accounts. Handles correspondence from third party payers appropriately. Requests reviews and appeals for denied claims. Assigns uncollectable accounts to collection agency or attorney. Knowledge of medical billing/collection practices. Knowledge of basic ICD-9 and CPT coding. Knowledge of insurance agency operating procedures and practices. Knowledge of governmental legal and regulatory provisions related to collection activities. Skill with computer applications and use of calculator. Ability to deal courteously with patients, co-workers and others. Ability to communicate clearly.

Essential Duties and Responsibilities

• Prioritizes delinquent accounts by age and dollar from Aged Receivables or other computer reports.
• Performs collection activities including contacting patients by telephone and resubmitting claims to third party payors. Follows company policy and procedures in collection activities.
• Evaluates patient financial status and establishes budget payment plans.
• Responds to correspondence by submitting copies of office notes, operative reports, etc. when requested.
• Reviews third party Explanation of Benefits (EOB) for appropriate payment.
• Reviews validity of denials; requests reviews and/or appeals.
• Answers patient questions and inquiries regarding their accounts.
• Identifies and resolves patient billing complaints.
• Reviews accounts for possible assignment to collection agency and makes recommendations to Practice Administrator.
• Participates in educational activities.
• Maintains strictest confidentiality.
• Performs related work as required.

Other

• Compiles information and prepares reports.
• Maintains records.
• Participates in educational activities.
• Follows organizational policies and procedures, including State of Franklin Healthcare Associates Compliance Manual, Code of Ethics and Business Standards, HR Policies and Procedures Manual, Team Member Handbook, OSHA Manual and any other policies or procedures for the job function, department, location or clinic.
• Performs other duties as assigned.

Education

High school diploma or GED.

Experience

Two years of collection experience in the medical field.

Certificates, Licenses, Registrations

N/A

Competencies

Service: Demonstrates high standards of service to patients, physicians, team members and other departments; remains calm when faced with challenging or difficult situations; effectively resolves service issues.

Quality: Work is thorough and accurate; offers ideas and solutions to improve outcomes and enhance service; considers the situation and relevant information before taking action; effectively implements improvements.

Integrity: Acts with the highest levels of personal ethics, honesty and accountability.

Performance: Applies job specific knowledge, skills and experience to accomplish results; requires appropriate level of supervision; work is completed in a timely manner; uses sound judgement in decision-making; is reliable and dependable; utilizes time and resources responsibly; complies with policies and procedures; work area is organized, neat and clean.

Communication: Expresses facts and ideas in a clear, convincing and organized manner; listens effectively; professional, respectful and compassionate in communications with others; follows proper channels of communication and shares essential information timely; maintains appropriate confidentiality.

Teamwork: Builds and maintains effective working relationships; recognizes strengths and contribution of others; manages and resolves conflicts in a positive and constructive manner.

Working Conditions

Work is performed in a medical office environment involving contact with patients, physicians, staff, insurance carriers and other business partners. Occasional local travel between work sites and additional hours, including evening or weekend work, may be necessary.

Physical Requirements

Not Required

Occasional

Frequent

Continuous

Walking

X

Standing

X

Sitting

X

Lifting

up to 10 lbs

X

up to 25 lbs

X

up to 50 lbs

X

Assisted lifting

X

Climbing

X

Bending

X

Pulling

X

Pushing

X

Vision

X

Color Vision

X

Hearing

X

Speaking

X

Chemicals/PPE

X

Pathogens/PPE

X

Outside Work

X