Patient Account Representative, Level II

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Efficiently and promptly manage patient accounts associated with billing, collections, and reimbursements for The Regional Medical Center in accordance with PFS standards, policies, and procedures.

• Achieve the necessary quantity and quality of collection calls each day.

• Gather essential financial and demographic details for patient claims.

• Oversee, follow up on, and investigate assigned patient accounts.

• Deliver courteous and professional customer service.

• Examine incorrect claims and investigate commercial guidelines to implement corrections and adjustments.

• Address patient and insurance company complaints, correspondence, inquiries, and requests for information.

• Collaborate with clinical departments and HIM to ascertain claim integrity and resolve claims.

• Update PFS management on errors, payer issues, registration challenges, and reimbursement-related activities.

• Investigate governmental requirements and apply regulatory billing changes.

• Collect balances from third-party payers in compliance with applicable legislation.

• Meet daily productivity benchmarks and process billing, rebilling, correspondence, EOB, report, and appeal files within designated timelines.

• Review and address suspended claims in electronic billing systems.

• Analyze discount reports and implement necessary corrections.

• Submit claims promptly and adhere to filing deadlines.

• Identify and relay denial information and work to resolve denials.

• Adjust BAR tables to ensure precise contractual adjustments.

• Confirm payment accuracy against claims, charges, terms, and procedures.

• Uphold thorough and ethical collection practices.

• Work collaboratively with the team to manage workload distribution.

• Evaluate associate training needs and provide instruction alongside PFS Managers.

• Convey findings, recommendations, and financial opportunities to PFS leadership.

• Engage in daily team briefings and metrics assessment.

⛳️ Requirements

• High School Diploma or equivalent.

• A minimum of 2 years of experience.

• Background in facility reimbursement, encompassing hospital billing, insurance collection, hospital payment validation, reimbursement verification, and/or refunds for government and/or commercial insurances.

• College education, prior insurance company claims experience, and/or healthcare billing experience may be acceptable in place of hospital experience.

• Understanding of governmental regulations regarding claims submission.

• Familiarity with billing and reimbursement prerequisites by payer.

• Capability to meet role-specific productivity standards.

• Ability to operate within applicable state and federal collection laws.

• No travel is required.

🏝️ Benefits

• Equal opportunity employer, welcoming veterans and individuals with disabilities.

• Fully remote work arrangement.