Post-Bill Patient Account Rep

Overview:

Job Summary:
Reporting to the Patient Accounts Supervisor and Lead, individual will be responsible for follow up on Medicaid/AHCCCS, Medicare, Commercial Insurance and Contracted claims directly with the payersResponsibilities:

Essential Functions:
Administration/Quality Assurance
- Responsible for making outbound phone calls to payer for follow-up of payment when working tickler files.
- Review and process all incoming remits, processing payer correspondence and patient correspondence.
- Ensure that all federal and payer guidelines are being met when submitting claims.
- Work directly with payers or provider representatives to resolve any payer issues.
- Process accounts correctly, following all federal payer requirements as well as Commercial payers and contracts billing guidelines.
- Manage workload to meet overall department objective set by management.
- Request cash adjustments and refunds accurately and timely based on R/M policies and payer requirements.
- Tickler files may be reassigned or additional task assigned at any time by the supervisor.
- Cross train to assist within the department or other departments for special projects.
- Ability to recognize payer trends and issues. If/When a payer trend is discovered that will have an immediate impact on incoming cash flow, notify supervisor.
- Works each denial as appropriate
- Provides or arranges for additional information as needed
- Submits corrected claims or appeals
- Requests Medicare hearings, when appropriate
- Bills a supplemental payer, the customer or adjusts the account
- Processes refunds to Medicare, when necessary
- Handles all Medicare correspondence
- Assist customer service in an efficient and helpful manner
- Post transactions to software system or computer files
- File or retrieve reports and records as needed
- Respond to requests for information
- Mail medical claims and correspondence as needed
- Make decisions and take appropriate actions based on sound reasoning and judgment.
- Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
- Plan and perform work systematically and efficiently.
- Carry out instructions, maintain a positive attitude, and support company policies/procedures.
- Punctuality and availability for workload.
- Comply with HIPAA guidelines
- Effectively work through denial/appeal process and meeting filing requirements
- Attend and maintain all required R/M training Customer Service
- The ability to provide service and quality communications exhibiting a professional attitude at all times. Compliance
- Complies and enforces all policies and procedures.
- Ensures and inspects paperwork for accuracy and compliance.
- Responsible for escalating concerns regarding questionable paperwork to appropriate management.
- Has successfully completed all required Compliance Training within the required time period.
- Has had no compliance related corrective action during the current review period. Additional Duties:

- All other duties as assigned or administeredQualifications:

Qualifications:

- Ability to read, write and speak English in an easily understood manner.
- Ability to type 40-50 wpm
- Strong medical terminology background,
- Basic understanding of HCPC codes and service levels
- Detail Orientation - proper keying of codes for charges and billing information and prompt expedition of paperwork
- Knowledge of HCRA 1500 forms and Medicare guidelines are essential for completion of the data entry process Education Requirements:

- High school diploma or GED Physical Requirements:

- This position can require long periods of sitting at a computer workstation. Must be able to lift up to 20 pounds when needed and move object/materials to locations that might be up to 20 feet away. Equipment Operated:

- General Office Equipment Working Conditions:

- The work to be performed will be done in an office environment. Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb or balance; stoop, kneel, couch, or crawl; and talk or hear. Occasionally:
Walking inside and outside, pushing, pulling, may lift and carry no more than 50 pounds. Frequently:
Lifting and carrying no more than 10 pounds, typing 40 wpm, stooping, bending. Constantly:
Hearing/listening, clear speech, touching, seeing, and typing. Cognitive/Psychosocial/Mental Requirements:
Occasionally:
Analyzing, judgment. Frequently:
Memorization, perception/computation, problem solving, simple and complex math skills, reasoning. Constantly:
Simple reading and writing, clerical, decision-making. Stress Factors:
Frequently:
Repetitive tasks, high pressure. Occasionally:
Fatigue, intense tasks Equipment Operated:
Occasionally:
Multi-media equipment for training purposes, voice recorder tape system Frequently:
Use Company and/or personal owned vehicle for business purpose Constantly:
Telephone, computer, mouse, keypad, calculator, copy machine, stapler, 3-hole punch, postage machine, fax, scanner, cell phone and/or blackberry, laminating machine, and printer Working Conditions:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Occasionally:
Outside Frequently:
Works around others, works alone, face-to face and verbal contact with others, inside, noise, extended day. Constantly:
Works with others, face-to-face and verbal contact with others. Closing Statement:
This brief summary is not an all-inclusive description of job duties. Other job duties and responsibilities may also be assigned by the incumbent's supervisor at any time based upon Company need. Rural/Metro is a proud Equal Opportunity employer, m/f/d/v.