Patient Account Representative 4 - Hospital (Medicare)
Company: St. Dominic Hospital
Location: Baton Rouge
Posted on: June 22, 2022
Job Title : Patient Accounts Representative 4 - Hospital
Job Summary : The Patient Accounts Representative 4 performs an
important function in the revenue cycle of the Health System. This
role is production based and works an assigned queue to coordinate
with patients, co-workers and external agencies to ensure the
prompt payment and/or reimbursement of hospital and professional
charges. The Patient Accounts Representative is responsible for the
customer service, billing and collection functions in the Business
Office. Key tasks include reviewing accounts on EPIC system,
providing information requested and applying critical thinking to
resolve issues between balances and/or credits belonging to managed
care vs the patient. This role responsible for collections on
delinquent insurance and patient balances and for working credit
balance reports, posting payments and adjustments, and filing
claims and appeals denials with managed care companies. Must meet
minimum performance and quality measures. This role is leverages
years of experience
* Experience : 8 years experience in Revenue Cycle / Hospital
Business Office programs (Customer Service, Billing, Follow-up) or
equivalent industry experience.
* Related certification program in areas such as billing, medical
office, coding and accounting can be substituted for 1 year of
* Bachelor's Degree can substitute for 4 years of experience;
Associate's Degree can substitute for 2 years of experience.
* Education : High School diploma or equivalent
* Special Skills : Must possess knowledge of ICD-9/10, CPT and
* Apply critical thinking and problem solving skills as it relates
to resolving accounts.
* Must understand the explanation of benefits of various managed
care companies and regulations.
* Must be able to demonstrate teamwork and willingness to work in
cooperation and support of others as well as comply with FMOLHS
policies, procedures and core values.
* Communication, interpersonal and collaboration skills.
Job Standards :
1. Execute Business Office Operations and Functions
* Performs billing, collections, payment processing and/or customer
service tasks according to documented process, applying critical
thinking to determine appropriate outcomes based on the
* Updates account with ownership and accountability of the entire
account at that point in time; Notes should be sufficient and
complete to describe current situation and next steps.
* Leverages contract knowledge and expertise to drive revenue
* Evaluates root cause and resolves issues on that specific account
being worked in timely manner to maximize revenue flow, minimize
write-offs and maintain customer satisfaction
* Completes most transactional updates with one interaction;
completes majority of work independently including most of the
complex scenarios and collaborates with other internal departments
and external entities as appropriate
* Identifies patterns, trends in account issues and escalates as
appropriate so root cause can be addressed and improved.
* Maintains subject matter expertise on regulations, process and
policies by attending training and applying in daily work
* Consistently meets production and quality requirements for area,
driving overall department objectives for A/R, Claim Counts and
* Responds to requests (from customers, co-workers, management) in
a timely and professional manner.
2. Planning and Support
* Assists with planning and participates in internal and external
meetings as a representative of department
* Serves as a subject manager expert to other team members.
* Provides training / shadowing support for new team members
* Identifies areas for improvement or fixes to system edits /
processes and communicates to appropriate owner to resolve
* Collaborates with Payor Relations and Vendors over contract
issues; researches Payor issues, coordinate to resolve payment and
* Creates & updates workflows, using SME knowledge and insight on
trends identified to drive process improvements
3. Other Duties as Assigned
* Leads special projects / updates
Keywords: St. Dominic Hospital, Baton Rouge , Patient Account Representative 4 - Hospital (Medicare), Healthcare , Baton Rouge, Louisiana
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