Website St. Croix Regional Family Health Center
The basic function of the Patient Account Representative is to locate and notify guarantors and/or third-party payors of delinquent accounts, to solicit payment and the timely submission of professional medical claims to insurance companies.
All potential new employees will undergo a background and Office of Inspector General exclusion report and periodically thereafter.
MAJOR DUTIES AND RESPONSIBILITIES:
- Post check receipts and miscellaneous monies received via the mail.
- Post insurance payments received via EFT
- Assist with Pre-verification responsibilities, as needed
- Check eligibility and benefit verification
- Review patient bills for accuracy and completeness and obtain any missing information
- Respond to inquiries concerning account balances. Third party payments, etc. from patients, relative and/or third-party payers in a timely manner
- Prepare, review and transmit claims using billing software, including electronic and paper claim processing
- Routinely review all claims that have been entered into the system for 30-45 days
- Check each insurance payment for accuracy and compliance with contract discount
- Contact insurance companies regarding any discrepancy in payments if necessary
- Identify and bill secondary or tertiary insurances
- All accounts are to be reviewed for insurance or patient follow-up
- Research and appeal denied claims
- Answer patient or insurance telephone inquiries
- Maintain appropriate files and records to effectively monitor payment and payment plan arrangements
- Keep up to date with statuses and regulations that could affect the collection of payment (i.e. insurance company changes, collection, regulations, etc.)
- Participates as an involved member in SCRFHC clinic team projects.
- Assist with QI activities.
- Attend required meetings.
- Self-direct, motivate and function successfully in a team environment.
The Patient Account Representative reports directly to the Finance Director.
EXPERIENCE AND/OR EDUCATIONAL REQUIREMENTS:
- Use of computer systems, software, 10 key calculator
- Effective communication abilities for phone contacts with insurance payers to resolve issues
- Customer service skills for interacting with patients regarding medical claims and payments, including communication with patients and family members of diverse ages and backgrounds
- Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
- Must be able to do basic arithmetic calculations to compute payments and payment plans
- Respect the confidentiality of patient and employee information
- Seek guidance and direction in the performance of responsibilities and duties
- Show ability to recognize and deal with priorities
PATIENT CENTERED MEDICAL HOME DUTIES:
1. Practices team-based care
2. Involved in huddles on daily basis per huddle procedure
3. Attends required staff meetings
4. Attends required training meetings
5. Participates in clinic and team Quality Improvement processes
6. Is invested in fostering patient self-management including involving the PCMH Care
7. Attend monthly meetings at which clinics, PCMH, and best-practice procedures and business agenda are addressed
8. Attend Performance Improvement Team and other QI committees as assigned
Completing assigned courses in Compliatric.
- Support and show gratitude to all coworkers.
- Agree to ask for help when needed and ask questions to learn; be willing to grow in your role and position at SCRFHC.
- Be part of the solution.
- Believe and participate in change and be willing to engage in improvement process.
- Model effective teamwork and collaborative communication.
- Provide respectful feedback (in a private setting) when encountering conflicts; ask for help from supervisor as needed.
- Understand and value that everyone’s role is important and contributes to the whole organization.
- Be willing to learn, cross train, and share knowledge.
- Model positivity.
- Understand that body language matters.
- Forgive and learn from failure.
- Agree to be flexible and adapt to organizational changes.
- Be mindful of challenges and burdens other colleagues may be facing and be kind.
- Honor and appreciate all forms of diversity.
St. Croix is an equal opportunity provider and employer.
To apply for this job email your details to email@example.com