Patient Accounts Representative
2 days ago
Del Amo Behavioral Health System is seeking a highly skilled Patient Accounts Representative to join our team. As a Patient Accounts Representative, you will play a critical role in ensuring the smooth operation of our revenue cycle process.
Responsibilities:- Verify patient account insurance information on the day of admission or the next working day.
- Contact patients and/or third-party payer organizations to secure insurance benefits and information.
- Secure all self-pay deposits and payments while patients are in the facility.
- Prepare bank deposits and post payments.
- Review explanation of benefits and apply contractual adjustments accordingly.
- Prepare daily cash reports.
- Prepare and submit refund requests to the Business Office Director for approval.
- Consistently review all information received daily from the Intake Department regarding insurance, demographics, and payment arrangement information.
- Consistently review any delinquent insurance information and report to the Business Office Director any self-pay accounts in the house as a result of no insurance.
- Consistently contact third-party payers and other appropriate persons to obtain additional information or clarification regarding patient insurance information.
- Consistently follow department policies and guidelines in obtaining, reviewing, and settling delinquent information.
- Regularly investigate apparent trends or patterns of delinquent patient information and report to the supervisor and co-workers on pertinent findings.
- Demonstrate proficiency in applying proper and effective account investigation/analysis and settlement techniques in performing job functions.
- Consistently follow up on problem delinquencies and develop recommendations for their proper disposition within three days of their identification as a problem.
- Consistently obtain appropriate additional information, clarification regarding insurance or third-party information to ensure the initiation of the proper follow-up action.
- Consistently respond to inquiries from Hospital personnel regarding current information relating to patient insurance information.
- Verify all insurance information on all admissions for the last 24 hours.
- Always use proper tact and discretion in handling inquiries and account settlement discussions with patients and their families.
- Consistently prepare all TARs for review and signature for utilization review and physicians within the allotted time frame to ensure proper payment for a future date.
- Copies medical records required to go with TAR.
- Enter all MIS information into the system within 24 hours of admission to ensure timeliness.
- Prepare all cross-over Medicare billing.
- Demonstrate a thorough knowledge and understanding of admitting procedures and the collection of proper information thereof in performing job duties and explaining insurance information to patients and third-party payer organizations.
- Accurately reclassify accounts within 24 hours of insurance verification if appropriate and bring to the attention of the Business Office Manager if there are any delinquencies.
- Obtain and analyze all pertinent information available to make the most informed decision based on factual and objective data.
- Demonstrate an understanding of the legal avenues available for facilitating the settlement of problem delinquencies.
- Consistently prepare recommendations for the referral of delinquent information to the Business Office Manager in a timely manner to facilitate their resolution.
- Consistently provide appropriate and logical justification for account disposition and recommendations.
- Consistently provide statistic information regarding information status and disposition reports in accordance with established schedules.
- Demonstrate knowledge to assemble and maintain records appropriately to increase overall efficiency to maximum potential.
- Consistently maintain census activity records in an organized manner.
- Always ensure the accuracy and completeness of records.
- Reviews all department insurance verification policies and procedures annually to maintain current knowledge level and proficiency in the department's operating guidelines.
- Regularly reviews legislation effective to all third-party reimbursement to remain aware of any pertinent changes in allowances or requirements.
- Demonstrate proficiency in automated systems including: MIS, PBX, Copy Machine, and Fax Machine.
- Demonstrate understanding of utilization review systems including eligibility, authorizations, benefits, and collections.
- Answer phones and cover the receptionist when needed. Ensure all who enter complete the COVID-19 Health Screening Form (screening form); assist with completion as needed. Takes the temperature of all who enter and logs temperature on the screening form. Reviews the form to verify if anyone entered if someone answered 'Yes' to being out of the country. Contacts the House Supervisor when there are positive screens for travel, close contact risk factors, positive COVID test, or fever > 100°F; seeks assistance when necessary. Maintains proper boundaries when interacting with patients, staff, and visitors. Ensures only authorized personnel are admitted onto facility premises.
- Demonstrate and is knowledgeable of the following policies and procedures for disaster and alarm response: a) Who to call; b) Checklist; c) Fire Department notification; d) House Supervisor notification; e) Triage procedures.
- Perform additional duties as requested.
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