Patient Account Representative- Business Office - Full Time/Days - Req#2080674128

Antelope Valley Medical Center


Date: 1 day ago
City: Lancaster, CA
Contract type: Full time
Brief Description

Job Objective:

Under the supervision of the Collection Supervisor, Director, or designee, performs patient account follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.

Duties and Responsibilities:

  • Insurance Follow-up, as assigned
  • Contact insurance carriers regarding outstanding balances until resolution
  • Resubmit bills to insurance carriers as needed
  • File insurance carrier appeals for payment and/or denial disputes
  • Validate accounts for accurate payments, discounts, and contractual adjustments
  • Reply to insurance carrier correspondence as appropriate
  • Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
  • Patient Follow-up, as assigned
  • Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
  • Contact patients regarding outstanding balances until accounts receivable resolution
  • Resubmit bills to insurance carriers as needed
  • Validate bills for accurate discounts and contractual adjustments
  • Set up payment plans and monitor until resolution
  • Refer uninsured accounts to Pre-Collection
  • Assign patient accounts to Bad Debt when appropriate
  • Communicate with TPL agencies and attorneys
  • Processes bankruptcy notifications
  • Review charity care applications and refers to the Director, or Collection Supervisor, for approval or denial
  • Credit Balance, Physician Payment, Trauma Billing, Client Billing, and Miscellaneous Reports Processing, as assigned
  • Process refund requests for patients and insurance carriers
  • Process uninsured claims for specialty physicians
  • Track and trend Medicare Bad Debt assignments for the Cost Report
  • Research unidentified checks for posting corrections

Non-Essential Duties:

  • Cancel Medicare and Medi-Cal eligible accounts from collection agencies, as assigned
  • Assist with other duties as assigned, within skill sets and abilities

Knowledge, Skills and Abilities:

Knowledge

  • Working knowledge of HMO, PPO, Commercial, Medicare HMO, Medi-Cal HMO, Government, and Workers' Compensation reimbursement
  • Working knowledge of Managed Care contract language and interpretation
  • Working knowledge of Microsoft Office applications
  • Knowledge of basic arithmetic

Skills

  • Knowledge of Proficient in basic personal computer
  • Knowledge of Proficient in the use of a calculator
  • Proficient in the operation of scanners, copiers, and fax machines

Abilities

  • Ability to handle stress
  • Ability to manage a heavy caseload in an organized and efficient manner
  • Ability to recommend appropriate account adjustment and write-off suggestions
  • Ability to recognize potential accounts receivable related problems and offer solutions to management
  • Ability to maintain a working relationship with other departments within the organization
  • Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges
  • Ability to document account information at time of account follow-up
  • Ability to run accounts receivable reports as needed

AVH Values: All AVH employees will effectively demonstrate these values:

  • Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
  • Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
  • Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
  • Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.
  • Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
  • Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
  • Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.

Education and Experience:

Education

  • High School graduate or equivalent

Experience

  • Minimum 1-year previous Commercial, HMO, PPO, Medicare HMO, Medi-Cal HMO, Government, and Workers Compensation billing and Insurance follow-up experience
  • Will consider 2-years’ recent acute care hospital Business Office experience

Required Licensure and/or Certifications:

  • None

AVH Conduct/Compliance Expectations:

  • Ability to adhere with AVH Absenteeism and Tardiness Policy
  • Ability to adhere with AVH Leaves of Absence Policy
  • Ability to adhere with AVH Paid Time Off (PTO) Policy
  • Ability to adhere with AVH Recording of Hours Worked Policy
  • Ability to adhere to the department dress code
  • Ability to organize work and establish priorities
  • Ability to expand on own initiative in performance of duties
  • Skill and ability to follow the telephone etiquette/standards
  • Conforms to AVH Standards of Excellence
  • Ability to function effectively under pressure and meet time parameters
  • Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff
  • Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH
  • Ability to maintain the confidentiality of patient, hospital and department information
  • Ability to adhere to safety rules and regulations
  • Safely and effectively uses all equipment necessary to carry out duties
  • Ability to interpret and function under hospital and department policies and procedures
  • Conforms with required and appropriate Joint Commission requirements
  • Conforms with and supports hospital quality assurance and improvement guidelines
  • Ability to participate effectively in department and hospital staff education
  • Display a willingness to work as a team player
  • Ability to give and support the highest level of patient/customer satisfaction at all times
  • Supports and adheres to the values and mission statement established by the AVH Board of Directors
  • Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.
  • Ability to follow the Code of Conduct

Physical Requirements and Working Conditions:

  • Primarily works in a climate-controlled area
  • Sitting 80% of time on duty
  • Tolerate repetitive arm and hand movements

A detailed description of the physical requirements of this job is maintained in the Employee Health Department.

Requirements

Education and Experience:

Education

  • High School graduate or equivalent

Experience

  • Minimum 1-year previous Commercial, HMO, PPO, Medicare HMO, Medi-Cal HMO, Government, and Workers Compensation billing and Insurance follow-up experience
  • Will consider 2-years’ recent acute care hospital Business Office experience

Required Licensure and/or Certifications:

  • None

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