Job Details

Patient Accounts Representative

Desert Sage Health Centers

The Patient Accounts Representative, a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. The Representative will assist in the clarification and development of process improvements and inquiries, assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues. Other important duties include enrollment processing, and reporting.

Billing and Claims:

• Prepares and submits clean claims to third party payers either electronically or by paper.
• Maintains relationship with clearinghouse, including appropriate follow-up with support issues.
• Coordinate the process of patient eligibility through various third-party sources.
• Coordinate collection process, to include any projects from Medisoft accounts and tracking current collections in eClinicalWorks.
• Field patient inquiries the Patient Registration staff need to escalate.
• Coordinate and administer policy and procedure for sliding scale.
• Work with patient registration staff, ensure appropriate collection of co-pay and self pay fees.
• Handles patient inquiries and answers questions from clerical staff and insurance companies.
• Identifies and resolves patient billing problems.
• Denial and insurance follow-up management.
• Issues adjusted, corrected, and/or rebilled claims to third party payers.
• Posts adjustments transfer of responsibility and refunds, as necessary.
• Assure coding is compliant and up to date.
• Reviews accounts and makes recommendations to the Patient Accounts Manager regarding non collectible accounts.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Reporting:

• Coordinate all non-financial aspects of the UDS as requested. Assist Patient Accounts Manager with financial aspects and assemble data tables from the EHR.
• Provide accurate compliance reporting data, reporting through EOB queries as needed.

Minimum Requirements:

• Knowledge of medical and/or dental billing and collection practices required.
• Strong keyboard skills.
• Works well in environment with firm deadlines; results oriented.
• Perform multiple tasks effectively.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making timely, independent decisions.

Technical Skills:

• Previous medical billing experience including knowledge of billing related reporting; 3-5 years' experience in health-care billing & collection practices, preferably with an FQHC.
• Experience working with medical payers including Medicare, Medicaid, and commercial insurance.
• Working knowledge of medical billing systems.
• Experience with Medicare and Medicaid's State Eligibility System.
• Working knowledge of CPT and ICD-10 coding systems; Coding certification preferred, but not required.
• A minimum of a GED is required, an Associate Degree from an accredited school is preferred.
• Excellent organizational skills.
• Proficiency in Microsoft Office Suite.