Patient Account Rep Job Description

Patient Account Rep Job Description

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Patient account rep provides customer service, billing, timely follow-up, cash application processes, reconciling payer remittance, denial management and appeal functions for claims to government or grant funded programs, worker’s compensation, commercial insurance.

Patient Account Rep Duties & Responsibilities

To write an effective patient account rep job description, begin by listing detailed duties, responsibilities and expectations. We have included patient account rep job description templates that you can modify and use.

Sample responsibilities for this position include:

Experience with medical terminology, insurance reimbursement, ICD-10 and CPT coding preferred
May maintain a large dollar inventory desk serve as just-in-time staffing, working inventory for team members that may be absent or backlogged
Effectively communicate issues to management, including payer, system or escalated account issues develop solutions
Reviews and researches claims for denials reason
Participate in the monthly, quarterly and annual performance evaluation process with the Supervisor
Processes statements according to departmental schedule for an assigned group of practices
Coordinates with the practices to ensure that the daily close functions are performed on a daily basis
Responsible for processing paper claims including the obtaining of office notes or other documents that are required to be attached to the claims for processing
Assists EDI Specialist as directed by the EDI Manager in reviewing edit reports and obtaining information from the physician practices
Reviews secondary claims to determine if any claims can be set up for piggyback filing to Medicare

Patient Account Rep Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Patient Account Rep

List any licenses or certifications required by the position: CPC, RHIT, CPR

Education for Patient Account Rep

Typically a job would require a certain level of education.

Employers hiring for the patient account rep job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Healthcare, Accounting, Medical Terminology, Education, Finance, Business, Health Care, General Education, Associates, Medical

Skills for Patient Account Rep

Desired skills for patient account rep include:

CPT
Federal
Standards
Medical terminology
Modifiers
State and compliance regulations related to billing and insurance
Payment posting and follow-up processes
Co-payments and deductibles
Insurance plans and current contracts
Medical insurance

Desired experience for patient account rep includes:

Utilizes problem solving skills to coordinate with revenue management team issues that may arise as it pertains to billing
Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs
Thorough understanding of HCFA 1500 and UB-04 billing required
Review Department and clinical department coding coordinators on retro authorization requests and appeals
Three (3) years computerized medical billing required or 1-2 years experience in Medical Business Office
Basic knowledge of governmental and managed care programs billing required

Patient Account Rep Examples

1

Patient Account Rep Job Description

Job Description Example
Our innovative and growing company is looking for a patient account rep. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for patient account rep
  • Performs insurance and co-pay follow up
  • This role will be responsible for assessing all payer specific regulations and procedures and will provide written summaries of findings and recommendations
  • This position is customer focused with emphasis on accounts receivable management
  • Process Home Medical Equipment referrals, provide customer service assistance and assist with other referral related duties
  • The incumbent is a liaison between Community Home Health Services, physicians, clinics, hospital personnel, third party payers, and other community agencies
  • This incumbent serves as a resource to external and internal customers
  • Majority of time will be spent fielding calls and scheduling patients in a call center setting
  • As the first point of contact (by phone) for the practice, greets patients in a professional and friendly manner, gathering information, scheduling new and existing patients with the appropriate physician, answering questions, and guiding and providing appropriate direction
  • Develops, maintains and conducts a comprehensive training program for new departmental Associates in areas such as policies, procedures, workflow and computer system operation
  • Responsible for the management and collection of revenue from patients’ accounts
Qualifications for patient account rep
  • Minimum of two years of documented outside sales success in a competitive, sophisticated environment (complex capital or tangible products including medical/surgical, copiers, payroll solutions, information systems)
  • Ability to travel domestically and within region often involving overnight stays and stays up to one week in duration
  • Bachelor’s Degree required (GPA of 3.0 or higher preferred)
  • Minimum of two years of documented outside sales success in a competitive, sophisticated environment, preferably tangible products
  • Typing 45 WPM, data entry
  • Typing, data entry, 10-key PC skills required
2

Patient Account Rep Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of patient account rep. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for patient account rep
  • Must be able to utilize and understand many complex and varying State and Federal statutes and regulations, guidelines and systems, and perform the account follow-up function with all Commercial payors and government agencies to obtain maximum and correct reimbursement of accounts receivables
  • Prepares and coordinates the publishing of educational material, training aids and A/R system documentation for distribution within and external to the immediate department
  • Review for accuracy and approve financial transactions for specified procedure numbers and dollars for posting to the accounts
  • Performs special projects for Patient Financial Services and Finance departments
  • Assist in maintaining and updating the Associates' attendance records
  • Interpret and communicate information regarding credit policies and procedures, billing practices, insurance submission and out-of-pocket patient responsibility
  • Accurate batch balancing and reporting
  • Submit claims to secondary insurers as required
  • Provide first-rate customer service as top priority in a transparent environment as an extension of our client
  • Runs & reviews 72 hour reports in CPA, two to three times each week
Qualifications for patient account rep
  • Must have 2+ yrs experience in the Medicare Billing and DDE exp, Collections and all aspects of A/R cycle
  • Must be proficient in Word & Excel
  • Previous experience with Medical Manager, Medisoft or other medical software highly preferred
  • Must have experience in a medical clinic, heavy medical billing, heavy A/R, collections (from insurance companies & patients), insurance follow-up and coding& verification
  • Works daily work files to keep A/R Days, 120 Days Plus, and Bad Debt within company Goals
  • Performs the outlined code practice as assigned
3

Patient Account Rep Job Description

Job Description Example
Our company is hiring for a patient account rep. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for patient account rep
  • Report any problems outside the normal work flow to supervisor
  • Processes emails in a timely manner and completes necessary actions
  • Proficient in ten-key entry required
  • Billing & Accounting.Assist leadership in overseeing the daily billing and accounting operations of the department, acting as a supervisor in his/her absence
  • Leadership.Under the direction of leadership, train new and existing personnel in billing/registration functions
  • Reviews Explanation of Benefits (EOBs)/ Electronic Remittance Advice (ERAs), payments, adjustments, insurance contracts and contracting system, insurance benefits, and all account comments
  • Posts and tracks electronic funds transfer (EFT) information and validates EFTs for accuracy
  • Follows write-off approval protocols for non-routine adjustments
  • Completes daily posting log and quarterly cash handling audits and reports findings to Supervisor/Manager
  • The Lead Patient Account Representative position is focused on interpersonal skills with internal and external customers, , leadership and Patient Account Representatives within Client Services
Qualifications for patient account rep
  • 1-2 years healthcare billing or collections experience required with a High School Diploma
  • Less experience required with a Healthcare Certificate or 2 or 4 year Degree
  • Medicare DDE (Direct Data Entry) Experience
  • Current immunization documentation required
  • Minimum 3 years’ experience and understanding of Commercial insurance hospital collections processes required
  • Minimum 3 years’ experience and understanding of Self-Pay/Customer Service hospital collections processes required
4

Patient Account Rep Job Description

Job Description Example
Our company is hiring for a patient account rep. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for patient account rep
  • This role supports the mission and values of CHNw by maintaining positive and productive patient/customer interactions and relationships both internally and externally
  • Contact payors, networks, patients, employers and other responsible parties to acquire timely and
  • Must be able to answer all billing questions including balance on accounts, how claims paid, patient responsibility
  • Participating in meetings/various committees
  • Making suggestions on workflow improvements
  • Notifies manager/supervisor of any customer service issues
  • Contact payors, networks, patients, employers and other responsible parties to acquire timely and accurate/expected payment on assigned Accounts Receivable inventory
  • Accounts should be worked daily, with an emphasis on quality and resolution
  • Worklists should be stratified to ensure high dollar and/or aged accounts are the top priority, with the overall goal of resolving assigned inventory each week
  • Must have working knowledge of Medi-cal including other complex payment methodologies to ensure prompt and accurate reimbursement
Qualifications for patient account rep
  • One year of medical billing experience required
  • Prefer knowledge of Medicare, Medicaid and third party payer guidelines
  • Prefer knowledge of home medical equipment and health care
  • 3-years prior physician billing experience, preferred
  • Knowledge of general billing and compliance regulations, preferred
  • Must be able to maintain confidentiality/discretion
5

Patient Account Rep Job Description

Job Description Example
Our innovative and growing company is looking for a patient account rep. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for patient account rep
  • Will works with all payors and internal resources to identify and resolve issues that hinder account payment
  • Will have working knowledge and understanding of Commercial managed care contracts including other complex payment methodologies to ensure prompt and accurate reimbursement
  • Analyzes billing errors to aid in claim resolution process improvement
  • Primarily focused on reimbursement for Medicaid, Managed Care, A/R, MDwise and other payers
  • Availity Management per assignment
  • The Patient Account Representative – Hospital Billing is responsible for managing all aspects of accounts receivables for assigned billing service clients to assure maximum reimbursement is being received
  • Be on the dialer 8-9 hours of the day with productivity goal of 85% of contacts and activity codes combined
  • Meet collection goals
  • Correctly set up promise to pay and hospital contracts
  • Process payments via Express bill
Qualifications for patient account rep
  • Ability to communicate and relate well with office staff, ancillary departments and the public
  • Ability to follow direction, accept orders and perform repetitive tasks
  • Computer literate – skilled in word processing, spreadsheets, and email
  • 0 to 1 year of related experience in bookkeeping, hospital patient accounting or banking preferred
  • Basic Keyboard, mouse and computer skills required with basic word processing skills
  • Experience with Blue Cross Blue Shield, Medicare, Medicaid and other insurance coverages desirable

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