Patient Account Representative - Chambersburg - Days

Position Function: Under the direction of the Patient Account Manager, is responsible for the billing of Medicare, Medical Assistance, Blue Cross, Highmark Blue Shield, Tricare, commercial insurance, managed care, auto, workers compensation and other payors to the appropriate intermediary or third party payor. Receives and reviews direct pay accounts, past due bills, and follow-up documents for all direct pay accounts of a specified collection group. Contacts payors and patients to secure payments or arrange alternative settlement plans.

Shift:

40 hours weekly, 8-hour shift. No weekends or holidays.

Essential Functions and Responsibilities
Unit Based Essential Functions and Responsibilities

Core Values: Service, Integrity, Compassion
1. Demonstrates service excellence and patient and family centered care by showing respect, honesty, fairness and a positive attitude toward all customers.
2. Maintains confidentiality.
3. Demonstrates dependability, to include attendance and punctuality.
4. Is accountable - takes initiative and ownership of issues.
5. Displays a professional demeanor. Represents hospital in a positive way. Has a compassionate working relationship with patients and families.
6. Assumes personal responsibility for 2-way communication. Communicates and listens effectively with patients, families, coworkers, other departments, physicians/providers and community.
7. Supports coworkers, initiatives and a patient and family centered philosophy; pitches in; does own part and helps others.
8. Works to continuously improve work environment/processes (Performance Improvement). Demonstrates a patient and family centered focus when considering/developing improvement solutions.
9. Represents willingness/enthusiasm to create, embrace and facilitate change.
10. Develops self and others; supports a learning environment; leads by example. Encourages patients and families to give feedback and suggestions for improvement.
11. Develops working relationships critical to the organization including patients, families, coworkers, other departments, physicians/providers and community.
12. Encourages others by providing recognition and support.

Technical Excellence

1. Thinks critically; utilizes sound judgment; promptly reports potential risks.
2. Maintains state of art knowledge of area of specialty, healthcare trends and practice, and populations served.
3. Maintains a level of computer literacy appropriate to their role.
4. Meets and maintains current all unit specific and organizational skills/competencies, certifications/licensures, as required.
5. Completes hospital-required reviews, e.g. HIPAA, safety, health screening,
care concerns, and others as assigned.
6. Adheres to National Patient Safety Goals.

Job Specifics
1. Understands Payor Regulations as they apply to billing, cash payments and patient responsibilities. Adheres to regulations. Reports any activity suspected as non-compliant to the Compliance Hot Line. Also, reports to Hot Line any situation where a person of influence has directed the employee to adopt a process suspected to be non-compliant.
2. Establishes and maintains accuracy, integrity, and completeness in all records, reports, and claims issued in conjunction with responsibilities.
3. Prioritizes workload at the beginning of shift so that important deadlines are met. Informs Assistant Patient Account Manager of any problems which would prevent the timely completion of work.
4. Handles all communication to patients, their agents, and Hospital agents with the highest regard for good customer service. Treats all external customers with a high degree of respect.
5. Attends scheduled departmental in-services and staff meetings to develop communication skills, learn new forms/procedures, etc.
6. Participates in special projects conducted by the department or other area as workload permits.
7. Participates in disaster and other emergency drills, M-1 disaster or evacuation.
8. Understands and follows hospital fire and safety procedures for satellite facilities, knows personal role in case of fire.
9. Maintains a neat, clean work area. Communicates housekeeping needs as appropriate.
10. Actively participates in the management of information either through a computerized fashion, manual or paper-based system.
11. Split for each Sorts Biller Queue daily. Identifies proper financial classification accounts. Keys insurance changes to be made prior to final billing.
12. Split for each Changes Collection Group, insurance information and updates statement information as appropriate, when pertient information is received or on a daily basis.
13. Verifies insurance coverage if applicable. Notifies Registration, Utilization Review and HIM of corrections and additions.
14. Immediately reports to Assistant Patient Account Manager any special situations or problems affecting receipt of payment.
15. Reviews mail daily; responds as appropriate, within five working days.
16. Participates in cross-training efforts to facilitate staff coverage during absences and to promote teamwork.
17. Identifies items to be scanned and appropriately scans to either the patient account or scans documentation in batches.
18. Reviews scanned documents for accuracy for future retrieval.

CPS Group
19. Keys adjustments for small balances, Charity write offs, and other charges not payable by insurance or the patient, as per established guidelines.
20. Staff completes bank deposits and ensures accuracy between deposits and what was posted to individual patient accounts in Meditech.
21. Reviews Bad Debt Recovery Report notifies collectors of payments, write-offs and differences in balances, daily. Responds to all correspondence from collectors daily.
22. Receives all inquiries pertinent to insurance information from patients, collectors, etc.; researches as appropriate, paying close attention to detail.
23. Reviews delinquent accounts and related documents; identifies additional information needs; contacts proper billing staff or other appropriate personnel to obtain pertinent information/clarification as needed.
24. arranges alternate payment plans based on department guidelines. Follows guidelines as outlined in policy and procedure.
25. Answers the phone in accordance with department policy. Takes complete phone messages to include caller data and response requested. Displays proper telephone etiquette and respect for external customers at all times.
26. Reviews self-pay surgical accounts prior to service to arrange payment.
27. Estimates charges as requested by patients wanting to comparison shop for services.
28. Meets department guidelines for maintaining all miscellaneous CPS WQ as required.
29. Meets department guidelines for ensuring accurate financial and biographical information.
30. Meets department guidelines for action items including follow up, rebilling, or adjustments.

HB Billing Group
31. Computes hospital bill. Mails or electronically submits itemized bills to include any necessary coding needed to comply with third party payor requirements. Completes billing by five working days following final billing.
32. Meets department guidelines for maintaining all miscellaneous biller WQ's as required.
33. Meets department guidelines for maintaining A/R Follow Up WQ's as required. Resolves accounts due to no payment on account balances in a timely manner. Appropriately notes accounts with claim status from insurance websites or insurance customer service.
34. Meets department guidelines for maintaining Claim Edits and Rejections WQ's as required. Makes telephone calls to insurance carriers, if needed, in order for resolve rejections in a timely manner.
35. Meets department guidelines of Denials WQ as required. Track, trend and investigate denials with insurance companies. Send appeals when required. Make sure account is ready to drop to secondary insurance. Bills any late charges when necessary.
36. Keys appropriate adjustments if claims have processed correctly.
37. Properly corrects insurance when receiving denials for incorrect coverage. Rebill account.
38. Enter or update patient data into computer.
39. Reports to Assistant Patient Account Manager any known Payor trends that may prohibit timely billing of claims or payments.
40. Researches cash receipts or payment transmittals for patient or insurance company refunds. References cash receipts or payment transmittals as source documentation for action taken, as per established guidelines and instructions.
41. Researches and completes refunds as per standard procedure.

Payment Posting Group
42. Posts insurance payments to proper account and bill number.
43. Reconciles clearing account for electronically posted remittances, daily/weekly.

PFR Group
44. As assigned, completes WellSpan Financial Assistance Application and Medical Assistance applications according to current guidelines.
45. Completes WellSpan Financial Assistance Application, bankruptcy weekly, as per established guidelines; prepares and maintains files in area of responsibility.

Qualifications and Standards

Education: High school graduate or G.E.D. required. Courses in bookkeeping, computing and accounting preferred. Informal or Continuing Education-As appropriate for updated billing trends, or techniques.

Experience: Experience applying customer service behaviors and communication skills required. Six months to one year experience in clerical work related to health insurance preferred. Typing skills at a minimum of 30 words per minute. Excellent organizational skills and experience in customer service required. Trained to operate a calculator.

Certifications/Licensure: None required.

Benefits Offered:

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support, including DailyPay
• Wellness and Wellbeing programs
• Caregiver support via Wellthy
• Childcare referral service via Wellthy