Patient Accounts Representative

1 week ago

Merrillville Indiana, United States Methodist Hospitals Full time

Overview:


The Patient Accounts Representative is tasked with the efficient management of billing and rebilling processes for all accounts, ensuring that claims are directed to the correct insurance providers by adhering to established billing protocols promptly.

This role is essential in pursuing the collection of all outstanding receivables from insurance entities, guarantors, and other liable parties.

Responsibilities:
PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)


Regularly follows up on overdue accounts by contacting third-party payers to promote swift resolution and/or payment, while also actively seeking payment from patients or guarantors for any remaining balances after third-party payments or denials, in accordance with hospital collection policies.

Identifies and examines delinquent accounts for unique circumstances that may hinder payment and suggests appropriate actions.


Reviews the bad debt prelist report to confirm that sufficient follow-up and collection efforts have been made before transferring accounts to the bad debt file on a weekly basis.

Contacts patients to gather insurance and coordination of benefits (COB) information, informs them of their financial obligations, and discusses various payment alternatives.

Prepares necessary billing documentation in line with current payer and hospital guidelines for all third-party payers.


Processes any required adjustments or coding modifications on accounts through the system based on follow-up actions to accelerate the collection process and ensure account accuracy on a daily basis.

Reviews inpatient and outpatient financials to verify the accuracy and completeness of all documentation.


Examines audit discrepancy reports, retrieves the relevant accounts, processes debit and credit adjustments, rebills the accounts to the third-party payer, and reallocates funds back to the insurance account.


Qualifications:
JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES

Familiarity with UB-04 and 1500 billing formats is preferred.

Must possess a solid understanding of insurance claim submissions, collections, and established refund processing protocols.

Productivity standards require handling a minimum of 75 accounts daily.

Quality benchmarks dictate that 95% of accounts receivable aged 90 days or less should not exceed 30% of total accounts receivable.

Accounts on work queues should not be aged beyond 30 days.

All mail and correspondence must be addressed within 5 working days.

Medical records requests should be followed up within 7 working days from the initial request.

Account rejections in the system must be resolved within 2 days of receipt.

Follow up with utilization management or physician offices regarding prior authorization denials within 1 day of receipt.

Bad debt accounts must be addressed weekly and resolved by the end of the month.

Daily resolution of patient complaints is required.

The denial write-off rate must remain below 0.5% of net revenue.

Ability to prioritize tasks, work independently, and exercise sound judgment is essential.

Strong written and verbal communication skills, along with good organizational, analytical, and mathematical abilities, are necessary.

Proficient use of calculators and a minimum typing speed of 55 words per minute is required.

Basic computer skills are essential.

EDUCATION
A High School Diploma or GED Equivalent is required.

An Associate's degree in Business Administration is preferred.

Experience in Healthcare/Medical Business Office is required.

STANDARDS OF BEHAVIOR
Adheres to the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.

CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE

Demonstrates an understanding of procedures for safeguarding and maintaining the security, confidentiality, and integrity of employee, patient, family, organizational, and other medical information.

Supports the commitment of Methodist Hospitals to comply with federal, state, and local laws, rules, and regulations governing ethical business practices in healthcare.


DISCLAIMER - The above statements are intended to describe the general nature and level of work performed by individuals assigned to this position.

The statements are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required.

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