Ambulatory Patient Account Representative

DEPARTMENT: PATIENT FINANCIAL SERVICES

F ACILITY: Medical Office Building

WORK TYPE: Full Time

S HIFT: Daytime

The Ambulatory Patient Account Representative reviews and submits claims to carriers and intermediaries via manual and electronic submission. Responds to questions regarding patient accounts. Collects delinquent insurance claims from insurance carriers.

* Works the assigned claim reports daily.

• Mails Insurance claims that cannot be electronically billed with medical records, if needed.
• Corrects any denied claims from insurance companies.
• Makes telephone inquiries to insurance carriers to collect delinquent claims.
• Documents all contact with patients, families, and inquiries made with employers or insurance companies.
• Keys insurance information into the computer and uses on-line claims correction.
• Updates patient and insurance company information in the computer.
• Documents account activity in on-line notes.
• Enters agreed items into computer.
• Answers all correspondence received from patients, lawyers, and insurance companies in a timely manner.
• Answers questions from patients or guarantors regarding insurance status.
• Researches patient accounts for information requested by management.
• Calls insurance companies to check the status of claims.
• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. (“TRHS”) policies as they presently exist and as they change or are modified.
• Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.
  

* High School Diploma or Equivalent

Two (2) years experience healthcare billing preferred.