KOS Patient Account Representative I

KOS Patient Account Representative I

Job Code: 50076

Position Summary

Responsible for billing, electronic claims submission, follow-up and collections of patient accounts, initiation of retro insurance authorization requests when necessary, research and analysis, accounting transactions, account refunds, and system maintenance functions in order to ensure optimal and accurate reimbursement is collected for services provided. Researches and resolves billing issues, utilizing knowledge of Current Procedural Terminology (CPT) codes and Ambulatory Surgery Center (ASC) medical billing and reimbursement methodologies. Works in close coordination with Patient Account Representative team.

Responsibilities

• Ensures audit and review accounts are prepped prior to surgery for current and accurate demographics, insurance payer information and call estimates are completed

• Actively reviews all payer claims for processing and receipt by the payer; if discrepancies are found, sends to appropriate work queue for follow up and resubmission

• Understands basic usage of clearinghouses and navigates sites for remit and claims data

• Maintains billing/accounts receivable work queues to determine what needs to be followed up on/request additional support

• Supports accounts receivable collections by issuing statements, handling outbound and inbound calls for payments or patient inquires

• Accurately identifies which payers need paper copies mailed and sent with the appropriate supporting documents

• Reviews Explanation of Benefits (EOBs) to determine appropriate payment and adjustments, and has a basic understanding of the appeals and 1st level denial processes for each payer

• Maintains basic understanding of Excel for maintaining records of payment data and production of ledgers for monthly accounting

• Covers scheduling and reception duties as needed

• Interacts with patients, clinicians, insurers, and registration to ensure timely correction of errors and to promote timely billing of accounts

• Answers telephones and direct callers to the appropriate department or unit

• Complies with Kootenai Outpatient Surgery policies and procedures

• Adhere to all training and accomplishments as required

• Operational needs of Kootenai Outpatient Surgery may require that you are available to work all shifts to meet the needs of the patients

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Performs other related duties as assigned

Requirements and Minimum Qualifications

• High school diploma or GED preferred

• Basic knowledge of registration, collection, and billing rules and regulations are required

• Previous accounting, billing, computer, and/or electronic health records experience required

• Previous experience with patient billing information systems required

• 2 years' experience in a similar position in a healthcare field preferred

• Prior experience utilizing a patient accounting system and electronic claims management preferred

• Medical terminology, ICD10, CPT4, HCPCS, and coding standards desired

• Knowledge of Medicare, Medicaid, and Commercial billing requirements including UB, 1500, claims and correspondence, Medicaid Claim Inquiry Form (CIF) and Appeals preferred

• Knowledge of how to read and interpret insurance billing and coverage bulletins, HIPAA, ABN, MSP and other payer regulations, remittance advices and explanation of benefits preferred

• Knowledge of Electronic Billing Software preferred

• Familiar with ASC payer contract interpretation and validation of appropriate reimbursement preferred

• Possess good communication skills, oral and written

Working Conditions

• Must be able to maintain a standing and/or sitting position

• Typical equipment used in an office job

• Must be able to stoop, crouch or bend

• Must be able to lift or move up to 10 lbs

• Must be able to reach arms above or below shoulder height

• Repetitive movements

Additional Information