About the position
The Patient Account Representative at Shelbourne Knee Center plays a crucial role in managing all aspects of accounts receivables to ensure maximum and timely reimbursement for services rendered in hospital billing and claims. This position is customer-focused, emphasizing accounts receivable management, and requires the representative to stay current on all payer-specific regulations and procedures. The representative will provide written summaries of findings and recommendations based on their analyses. The role involves following established guidelines to recover delinquent accounts with payers, which may include placing calls to collect payments and assisting in maintaining Network A/R days. Follow-ups may also be conducted through payer websites when appropriate. The Shelbourne Knee Center is a multi-disciplinary orthopedic ambulatory office located at Community East Hospital, staffed by two physicians and one Advanced Practice Provider (APP). The center boasts a dedicated team, including a nine-person in-house physical therapy department, a two-person in-house billing department, a four-person research department, and a five-person front office and scheduling department. The culture at Shelbourne Knee Center is patient-focused, team-oriented, and collaborative, which contributes to consistently high patient satisfaction scores. The Patient Account Representative will be part of a two-person in-house billing department responsible for both hospital and professional billing for the office. The ideal candidate for this position must be self-motivated, adaptable to change, and possess a team mentality. This role also offers the flexibility to work from home after completing the initial training period, allowing for a balance between professional responsibilities and personal life.
Responsibilities
- Manage all aspects of accounts receivables to ensure maximum and timely reimbursement for services performed for hospital billing and claims.
- Stay current on all payer-specific regulations and procedures.
- Provide written summaries of findings and recommendations based on analyses.
- Follow established guidelines to recover delinquent accounts with payers.
- Place calls to payers to collect payments and assist in maintaining Network A/R days.
- Conduct follow-ups through payer websites when appropriate.
- Document all actions taken on accounts in the system account notes to ensure clarity for others.
- Ensure confidentiality of patient records.
- Resolve denials within specified timeframes.
- Address insurance correspondence scanned into mail queues.
- Follow billing and collection procedures as outlined in policies and provide necessary information to adjudicate claims.
- Maintain A/R to meet Network set goals.
- Meet productivity standards designated by the department.
- Meet QA standards designated by the department.
- Monitor billing and follow-up holds at all sources and ensure timely resolution of assigned tasks.
- Participate in monthly conference calls with specific payers.
Requirements
- Two or more years of experience in revenue cycle healthcare within a medium to larger healthcare system.
- Knowledgeable regarding payer billing guidelines.
- High School Diploma or GED required.
- Adhere to all network and departmental procedures and policies.
- Comply with applicable state/federal laws and program requirements of accreditation agencies and federal, state, and government health plans.
- Document all actions taken on accounts in the system account notes to ensure clarity for others.
- Ensure confidentiality of patient records.
- Follow appropriate steps to resolve denials within specified timeframes.
- Follow appropriate steps to resolve insurance correspondence scanned into mail queues.
- Follow billing and collection procedures as outlined in policies and provide necessary information to adjudicate claims.
- Maintain A/R to meet Network set goals.
- Meet productivity standards designated by the department.
- Meet QA standards designated by the department.
- Monitor billing and follow-up holds at all sources and ensure timely resolution of assigned tasks.
