Tenet Healthcare

Patient Account Representative

Tenet Healthcare

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $16 - $24 per hour

Job Level

Junior

About the role

  • The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable.
  • An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.
  • Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account.
  • Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
  • Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions
  • Access payer websites and discern pertinent data to resolve accounts
  • Utilize all available job aids provided for appropriateness in Patient Accounting processes
  • Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
  • Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
  • Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities
  • Provide support for team members that may be absent or backlogged
  • Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
  • Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
  • Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
  • Participate and attend meetings, training seminars and in-services to develop job knowledge.
  • Respond timely to emails and telephone messages as appropriate.
  • Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

Requirements

  • Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
  • Intermediate skill in Microsoft Office (Word, Excel)
  • Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently
  • Ability to communicate in a clear and professional manner
  • Must have good oral and written skills
  • Strong interpersonal skills
  • Above average analytical and critical thinking skills
  • Ability to make sound decisions
  • Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
  • Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
  • Intermediate understanding of EOB.
  • Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
  • Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.
  • High School diploma or equivalent. Some college coursework in business administration or accounting preferred
  • 1-4 years medical claims and/or hospital collections experience
  • Minimum typing requirement of 45 wpm