Hospital AR Collections Representative

📋 Description

• The Patient Account Representative is tasked with ensuring accounts are addressed promptly.

• Responsible for following up on claim submissions, reviewing remittance for insurance collections, and creating and pursuing disputed balances from both government and non-government entities.

• Conducts research for each account using the company's patient accounting systems and online resources.

• Engages in appropriate account activities for uncollected balances by contacting third-party payors and/or patients via phone, email, or online methods.

• Identifies and resolves issues to enhance revenue collection while minimizing rework.

• Updates plan IDs, modifies patient or payor demographic/insurance details, documents account information thoroughly, identifies payor trends and issues, and addresses recoup issues.

• Requests necessary information from patients, medical records, and other documentation as needed by payors.

• Reviews contracts to identify any billing or coding discrepancies and requests re-bills, secondary billing, or corrections as necessary.

• Takes suitable actions to achieve timely account resolution or initiates a dispute record for further research and substantiation for ongoing collection efforts.

• Maintains desk inventory to ensure currency without backlog while meeting productivity and quality benchmarks.

• Undertakes special projects and additional responsibilities as required.

⛳️ Requirements

• High School diploma or equivalent; some college coursework in business administration or accounting is preferred.

• 1-4 years of experience in medical claims and/or hospital collections.

• Minimum typing speed of 45 wpm.

• Comprehensive understanding of the revenue cycle process, covering patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.

• Intermediate proficiency in Microsoft Office (Word, Excel).

• Ability to learn hospital systems such as ACE, VI Web, IMaCS, and OnDemand quickly and proficiently.

• Capable of communicating in a clear and professional manner.

• Excellent oral and written communication skills.

• Strong interpersonal abilities.

• Above-average analytical and critical thinking skills.

• Competent decision-making capabilities.

• Thorough understanding of Commercial, Managed Care, Medicare, and Medicaid collections, along with intermediate knowledge of Managed Care contracts, contract language, and Federal and State requirements for government payors.

• Familiarity with terms such as HMO, PPO, IPA, and Capitation, and how these payors process claims.

• Intermediate knowledge of Explanation of Benefits (EOB).

• Intermediate understanding of hospital billing form requirements (UB04) and familiarity with HCFA 1500 forms.

• Aptitude for problem-solving, prioritizing tasks, and ensuring complete follow-through on assigned duties.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance.

• Paid time off (vacation & sick leave) – a minimum of 12 days per year, accruing at approximately 1.84 hours per 40 hours worked.

• 401k with an employer match of up to 6%.

• 10 paid holidays annually.

• Health savings accounts, healthcare, and dependent flexible spending accounts.

• Employee Assistance Program and Employee Discount Program.

• Optional benefits include pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder & childcare, AD&D, and auto & home insurance.

• For employees in Colorado, Conifer provides paid leave in compliance with Colorado’s Healthy Families and Workplaces Act.