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Patient Account Representative

Company: Beaver Medical Group
Location: Redlands
Posted on: May 16, 2022

Job Description:

Job Description JOB FAMILY SUMMARY: The Patient Accounts Rep job family is distinguished by the level, scope and realm of responsibilities within the Patient Financial Services Department. Levels I and II positions are primarily that of processing, recording, ensuring the accuracy of patient billings under the guidance of the Supervisor. Levels III (Lead) positions are generally focused on more complex operational transactions and the scheduling and monitoring of department staff activities under the general direction of the Supervisor and/or Manager. DISTINGUISHING CHARACTERISTICS: The Patient Accounts Rep I works under minimum supervision to perform various routine and complex clerical tasks; works directly with multiple insurance payers to ensure proper reimbursement of insurance claims. The Patient Accounts Rep II works under general supervision to perform various routine and complex clerical tasks within Patient Financial Services; maintains positive working relationship with patients, staff and third parties; and, represents the organization in a professional manner. The Patient Accounts Rep III (Lead) works under general supervision to perform various routine and complex clerical tasks with Patient Financial Services including the education/coordination of more technical transactions among staff from other departments. Additional responsibilities are work assignments, monitoring work flow/quality, attendance/time off, and recommendations for performance evaluations and corrective actions. Participates in the hiring process, making recommendations to a Supervisor or Manager. Promotes collaboration and team spirit at all times to maximize group effectiveness, including offering assistance and encouragement to others. Projects a mature, compassionate, concierge-style customer service attitude and professional demeanor while dealing with patients, staff and all parties encountered. SUPERVISORY RESPONSIBILITIES: Limited - III (Lead) level position has supervisory duties for the purpose of workflows, attendance, orientation, training, assistance and review/monitoring of tasks assigned to I/II level staff. ESSENTIAL JOB DUTIES & RESPONSIBILITIES: The following are exemplary essential job duties and responsibilities and are not intended to represent an all-inclusive listing of related essential functions of the position PERFORM DEPARTMENT DUTIES IN A TIMELY AND EFFICIENT MANNER: Patient Accounts Rep I 1. Contacts insurance carriers/patients regarding outstanding insurance claims to obtain proper payment. 2. Prepares proper documentation for appeals to insurance carriers 3. Ensures all accounts are set-up correctly in the computer using knowledge of A/R software, understanding of eligibility requirements and use of the internet 4. Has thorough knowledge of insurance carrier procedures and processes 5. Understands contract reimbursement rates for individual carriers/networks 6. Processes refunds when applicable 7. Responsible to investigate and correct prepayments 8. Works an untagged report ensuring all charges are billed to correct payer 9. Must meet minimum production standards as set by management 10. Responsible for a book of unpaid claims that appear on a worklist assigned to each OTHER WORK AS REQUIRED/REQUESTED May be assigned special project or other assignments and work tasks that are generally within the scope and level of the position, and relative to the need for flexible Company operations. MINIMUM & PREFERRED QUALIFICATIONS: Education/Training Minimum: High School diploma or equivalent. Preferred: Associates Degree in Medical Billing/Terminology. Experience Minimum: One year of experience in medical insurance billing or six month of McKesson Practice Plus experience. Preferred: Two years of experience in medical insurance billing Certification(s) None Driver---s License Valid California driver---s license required and insurability under the company---s insurance carrier standards as applicable to job requirements. Skills, Knowledge & Abilities Appropriate English usage, spelling, grammar, punctuation; knowledge of basic arithmetic concepts; ability to operate standard office machines; basic application of CPT's. Excellent telephone skills. Ability to complete tasks in a timely and accurate manner; and compliance with department and organization policies and procedures. Strong verbal/written communication and customer service skills. Bilingual a plus. Ability to successfully uphold the established customer service standards and Company Mission Statement. Knowledge of medical billing and coding systems; ability to assess work responsibilities and prioritize; keeping supervisors/managers apprised of status on a routine basis; and, keen insight in problem solving relative to billing, in general. Must be able to understand payer---s procedures and policies as they pertain to payment of claims; be able to calculate proper reimbursement based on contracts; and have the ability to make critical decisions regarding resolutions of claims. OTHERS: Work with spirit of enthusiasm, teamwork, cooperation and a sense of urgency Maintain a high degree of confidentiality over all matters in the course of business operations including patient and employee information Ability to multi-task in an efficient, thorough, and prioritized manner Good working knowledge and intermediate/advanced use of Word, Excel, GroupWise, Internet Ability to work quickly. accurately and independently Ability to anticipate needs and solve problems Excellent written and verbal communication skills -- Promotes and exhibits outstanding customer service PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit; use hands to touch, handle or feel objects, tools, or controls; and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must have the ability to sit at a desk and read a computer terminal for extended periods of time; must occasionally have to reach up and pull heavy manuals and books and file in areas above the head; and, must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderate. Company Description Beaver Medical Group is one of the largest medical groups in Southern California with many services located on-site. Over 200 physicians, along with other medical professionals including Optometrists, Physical Therapists, Nurse Practitioners, Physician Assistants and Health Educators practice in 25 specialties. OUR MISSION is to deliver exceptional quality healthcare management, professional and support services with a firm commitment to excellence, integrity and innovation, making a lasting difference in the lives of patients and our communities. We collaborate with medical groups and health care providers, offering expertise and insight to meet their unique challenges. Our patient services are built on a foundation of compassion, trust and respect. We strive to build an outstanding team, offering opportunities for growth, recognition and reward in an environment of open communication, trust and mutual respect. Our services will grow and improve as we create value for our investors and provide mutual benefit for our partners.

Keywords: Beaver Medical Group, Redlands , Patient Account Representative, Other , Redlands, California

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