Patient Accounts Representative

Job Description

Patient Accounts Representative is responsible for reviewing, billing, collection, and accounts receivable activities for the hospital (and in some cases the physician) billing departments within Saint Luke's Health System. Activities include, but are not limited to, entering demographics, troubleshooting issues, responding to inbound and outbound billing calls from patients, payment posting, resolving credits, identifying, and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Patient Account Representative may be responsible for any or all the following duties, including duties not otherwise assigned.

Payments

• Responsible for EDI transmissions, electronic, and manual payment posting

• Resolve electronic remittance errors

• Responsible for recording daily Epic posting batches to cash deposit

• Balance payment batches posted in Epic to cash deposits and resolve variance

• Resolve payment posting errors

• Research missing checks, payments, and/or EOBs which may include contacting payors

• Responsible for processing virtual credit card payments from payors

• Responsible for opening mail with checks and route to appropriate area/address

• Responsible for indexing HB-EOB scanning queue in On Base and processing zero pays if applicable

• Responsible for assigned work queues within Epic

• Responsible for assigned Unidentified accounts in Epic

• Responsible for researching/resolving incoming faxes and Group email box

Credits

• Responsible for reviewing patient/guarantor accounts and investigating credit balances (includes reviewing overpayments from insurance companies and patients)

• Investigate Undistributed payments in Epic system to determine if should be re-distributed or refunded

• Identify trends causing credits and escalate to other team members for resolution

• Work assigned work queues within Epic timely

Customer Service Call Center

• Responsible for answering inbound patient calls

• Answer patient emails in Electronic Medical Record system

• Making outbound collection calls to patients to obtain information needed to collect payment

• Provide price estimates for patients

• Process credit card payments

• Establish payment plans with patients and complete referral to extended payment plan vendor when applicable

• Identify patients needing financial assistance, explain financial assistance process and additional documents needed

• Research and troubleshoot issues related to patient balances

• Serve as liaison between patient and other departments as needed

• Process incoming mail and faxes

• Process accounts within a work queue in the Electronic Medical Record system and take action as appropriate

• In SBO will also:

• Perform straightforward coding (i.e. Review patient charts for billing implications or referrals)

• Meet department productivity and quality metric

• Identify opportunities and report trends to improve patient satisfaction and workflow efficiencies by identifying reasons for patient calls that could have been prevented by education up stream in the process or practice management programming solutions. Examples of this would be educating patients on financial policies, financial expectations of services rendered, correct coding, explanation of coverage, collecting payments when scheduling, system enhancements to identify the correct insurance at registration, correct payment posting, medical necessity warnings.

Financial Counseling (Critical Access Region)

• Responsible for patient walk in's, payments, complaints, and questions

• Responsible for answering inbound patient calls

• Make outbound collection calls to patients to obtain information needed to collect payment

• Provide price estimates for patients

• Process credit card payments

• Establish payment plans with patients

• Assist on site patients needing financial assistance, explain financial assistance process and additional documents needed

• Research and troubleshoot issues related to patient balances

• Serve as liaison between patient and other departments as needed

• Process incoming mail and faxes

• Process accounts within a work queue in the Electronic Medical Record system and take action as appropriate

• Assist remote staff with printing and mailing of claims for payment

• Handle upfront collection process prior to scheduled services when required

Patient Balance Team

• Review and process financial assistance applications, complete follow-up with patients for missing documents, complete presumptive eligibility run when applicable and post adjustments once approved

• Review past due accounts to determine eligibility of placement with collection agency

• Review patient credit balances to determine eligibility of patient refund

• Resolve balances for deceased patients via surviving spouse update, estate searches and the filing of estate claims

• Process notices from bankruptcy court and take appropriate actions on accounts so patients are not billed inappropriately

• Process return mail, update address and follow-up levels as applicable

• Process attorney ROI billing requests

• In SBO will also:

• Meet department productivity and quality metric

• Identify opportunities and report trends to improve patient satisfaction and workflow efficiencies by identifying reasons for patient calls that could have been prevented by education up stream in the process or practice management programming solutions. Examples of this would be educating patients on financial policies, financial expectations of services rendered, correct coding, explanation of coverage, collecting payments when scheduling, system enhancements to identify the correct insurance at registration, correct payment posting, medical necessity warnings.

Claim Processing

• Responsible for researching patient billing claims to correct claim errors

• Understand respective payor requirements so claims are processed correctly

• Familiar with NCCI / NCD / LCD edits, incidentals/inclusive, and bundling rules, etc.

• Work with multiple teams/departments to resolve issues

• Hand billing of specialty care which may include residential care, transplant and research

Insurance Denials

• Responsible for researching, identifying errors, and correcting claims denied by insurance companies.

• Responsible for writing appeal letters to insurance companies

• Research refund request from payor organizations

• Responsible for preliminary audit of billing code errors before claim resubmitted from denial

• Responsible for becoming a subject matter expert on the payor policies

• Payment posting corrections/adjustments and ability to distribute payments

Insurance Follow-Up

• Responsible for following up with insurance companies for unpaid claims

• Responsible for communicating and resolving problems with the provider representatives when applicable

• Payment posting corrections/adjustments and ability to distribute payments

• Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage claim rejection/no pays

Client Accounts

• Responsible for reviewing all accounts at the beginning of the month to make sure they are ready for statements.

• Work with clients on any billing questions they have

• Client refunds

Job Requirements

Applicable Experience:

1 year

Diploma

Job Details

Full Time

Day (United States of America)

The best place to get care. The best place to give care. Saint Luke's 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.