Patient Account Representative Job Description

Patient Account Representative Job Description

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Patient account representative provides front line phone support for computer applications, computer-related hardware and mobile email devices / PDA’s.

Patient Account Representative Duties & Responsibilities

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

Sample responsibilities for this position include:

OVerifies insurance benefits of all insurance admissions daily (Medicaid coverage/eligibility when applicable)
OCoordinates when required the Medicaid application process including collecting all required information from respective parties
File Medicaid premium offset requests and follow up
Primarily focused on Behavioral Health UB and 1500 claims follow up to assure maximum reimbursement is received
Review and prepare claims for electronic and hard copy billing submission
Identify and correct billing errors and resubmit claims to insurance carriers
Review Remittance advice for payment errors, denials and under payments
Initiate appeals when necessary
Act cooperatively and courteously with patients, visitors, co-workers, management and clients
Analyze weekly denial reports to spot trends

Patient Account Representative Qualifications

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

Licensing or Certifications for Patient Account Representative

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

Education for Patient Account Representative

Typically a job would require a certain level of education.

Employers hiring for the patient account representative job most commonly would prefer for their future employee to have a relevant degree such as High School and Associate Degree in Healthcare, Business, Medical, Education, Computer, Medical Billing, Finance, Pharmacy, Associates, Communication

Skills for Patient Account Representative

Desired skills for patient account representative include:

Word processing
Email applications
Spreadsheet
Spreadsheet and email applications
Computer billing systems
Especially X-claim
Excel
Third Party Payers
Medicaid
UB

Desired experience for patient account representative includes:

OCoordinates with Utilization Review department to ensure all pre-certifications are in place on all admissions, and obtain all pertinent data for patient accounting
OEnsures that all admission forms are properly completed, signed and in place
OCreates patient financial files
Promptly answer phones in a courteous and friendly manner utilizing a pleasant voice inflection
Process correspondence with insurance companies (requests for medical records, etc)
Check status of claims utilizing the websites for various insurance companies

Patient Account Representative Examples

1

Patient Account Representative Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of patient account representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for patient account representative
  • Identifies coding or billing problems from EOBs and works to correct the errors in a timely manner
  • Updates the account database to identify actions that have been taken on the account
  • Work with clinic and clinic managers to resolve outstanding insurance balances
  • Generates and monitors all work lists specific to the collections role
  • Ensures timely receipt of claim payments and minimization of unexpected bad debt
  • Monitoring of assigned work lists and working with appropriate clinical regional
  • Performs account receivable collection duties as assigned by billing supervisor
  • Responsible for transferring balances to correct payer, and initiates re-bill of unpaid claims
  • Contacts the patient's and/or third party payer organization(s) to secure insurance benefits and information
  • Secures all self-pay deposits and payment while patients are in the facility
Qualifications for patient account representative
  • Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written
  • Ability to prioritize and multi task and to work in a fast paced environment with a positive attitude
  • Knowledge of MS4, Midas, Emdeon would be preferred, but not required
  • Monitors and reviews all new accounts and follow-up documents to determine the nature and extent of the information received from and the Intake Department
  • Notifies the Business Office Manager of any delinquent information
  • Contacts all payers to ensure clarification of insurance benefits and any monies due up front
2

Patient Account Representative Job Description

Job Description Example
Our company is hiring for a patient account representative. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for patient account representative
  • Reclassifies accounts after insurance verification or rejection or verification and initiates required procedures
  • Identifies problem delinquencies and recommends further action needed
  • Maintains current knowledge of all insurance verification policies and procedures and related legislation
  • Instructs and assists patients with federal, state, county or third-party payer eligibility forms, applications and processes from computer-generated reports/referrals
  • Properly matches self-pay patients to a variety of third-party payer programs according to the guidelines of the reimbursement programs
  • Provides or arranges for translation when necessary
  • Updates and completes proper forms and documentation according to procedure for the coding, closing and suspending of accounts while updating account files
  • Responsible for maintaining strong communication with Manager, informing the Manager of any upcoming hospital activities or any non-routine situations
  • Research Credit Balances
  • Primary contact for new Special Care Insurance Program markets
Qualifications for patient account representative
  • Able to avoid making erroneous decisions or failure to take appropriate actions/steps may expose the Company or Hospital Client to lost revenue, and if a HIPAA violation, potential legal liabilities
  • This position is responsible for making decisions on routine problems and working with their Manager with non-routine questions
  • Routine contact with the Hospital Staff and Patients, Regional Director, Operations Manager, Operations team members and Third-Party Payers
  • Data entry of charts, correspondence, or account notes as needed
  • Knowledge of MS4, Midas, Emdeon/Change a plus but not required
  • Enroll, bill and administer policies for residents
3

Patient Account Representative Job Description

Job Description Example
Our innovative and growing company is hiring for a patient account representative. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for patient account representative
  • Under general supervision, post electronic and manual cash receipts, adjustments and denials
  • Identifies problem accounts with payors
  • Calls the individual insurance companies and patients whose balances are past due and conducts follow through with any research, re-filing, that needs to be done to obtain maximum payment
  • The Patient Account Representative is responsible for preparing and submitting claims to appropriate payer(s) for payment in a timely and accurate manner while assuring the integrity of all claims
  • Responsible for monitoring, evaluating and resolving assigned accounts receivable to meet the department's guidelines and goals
  • Maintains a system to correct problems pertaining to reimbursement issues and claims status
  • The Patient Account Representative primary responsibilities support the patient accounts department by communicating with insurance companies, utilization review staff, and clinical staff regarding claim and reimbursement issues
  • Knowledge of governmental and third party payer billing and reimbursement methodology necessary
  • Availity Denial Management per assignment
  • Verifies and updates insurance information as required
Qualifications for patient account representative
  • Participates in establishing priorities for specific departmental functions and activities
  • Assists Manager in the development of educational/training materials related to the department’s functions
  • 1 to 3 years hospital-patient accounts
  • Management or specialized related experience in collections, accounting systems
  • Must demonstrate good customer-service skills, strong written and verbal skills
  • An ability to accurately investigate complaints, errors, and other operational problems and recommend the appropriate corrective action
4

Patient Account Representative Job Description

Job Description Example
Our company is looking for a patient account representative. 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 representative
  • Review and manages underpayment reports
  • Appeals on denied claims as deemed necessary and appropriate
  • Manages daily/weekly/monthly reports
  • Knowledgeable of hospital and services offered
  • Works main cash box efficiently and effectively
  • Receipts and post payments accurately
  • Reviews, corrects and approves all primary and secondary billing, submits hard copy or electronic claims to appropriate payors
  • Responds to all requests for information and telephone inquiries from patient, insurance carrier, physician office and outside agencies in a courteous manner
  • Responds to all requests for information and telephone inquiries from patient, insurance carrier, hospital business office and outside agencies in a courteous manner
  • Evaluate account information received from the client to determine next step to resolve account and take the action necessary
Qualifications for patient account representative
  • Ensures HIPAA compliance in all business practices
  • Third-party Eligibility experience is preferred
  • Two to three years related experience in healthcare strongly preferred
  • Work requires knowledge of health care billing and collection processes including federal and state collection laws, collection practices and techniques at a level generally acquired through min
  • Minimum of 3 years experience in a patient accounting or medical insurance environment preferred
  • A minimum of one year of customer service experience and knowledge of current insurance processes and terminology is preferred but not required
5

Patient Account Representative Job Description

Job Description Example
Our company is growing rapidly and is hiring for a patient account representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for patient account representative
  • Ensure the integrity of each claim that is billed is in accordance with payer regulations
  • Document in detail all efforts in the required systems
  • Verify patient information and benefits as required
  • Responsible for the maintenance of practice Accounts Receivable according to guidelines
  • Accounts Receivable maintenance includes but is not limited to claim filing, responding to correspondence in a timely manner, assisting patients with questions in regards to their account, and completion of collection steps
  • Treating all clients with dignity and respect
  • Persuade consumers to pay and/or set up payment arrangements and settlements on account balances
  • Negotiate payment terms and methods
  • Utilize skip tracing as needed
  • Learn and adhere to HIPAA and PCI compliance requirements
Qualifications for patient account representative
  • Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbal and written
  • Medical Billing and/or Medical Admin experience a plus!
  • Ability to Read EOB's
  • Must be able to communicate effectively and professionally with attention to details and problem solving both verbal and written
  • Associates in Medical Office Management, Business, or Accounting preferred
  • Knowledge of basic accounting principles and patient accounts

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