Patient Account Services Representative is responsible for the revenue cycle management of a claim for all payer sources. This includes reviewing claims prior to billing based on established system edits. After initial billing it includes, monitoring, correcting and re-billing claims for Medicare, Medi-Cal, Managed Care, Private Insurances, CHDP, Family Planning, EWC, Private Pay, and Sliding Fee patients until the balance of the claim is zero.
MAIN RESPONSIBILITIES AND DUTIES:
- Review claims prior to billing that require manual intervention, based on specific criteria for that payer source to include Medi-Cal, Managed Care, Medicare, CHDP, Family Planning, EWC, private insurances, sliding fee and self pay.
- Print secondary claims, attach EOB for any payer who does not accept electronic secondary's.
- Check the patients eligibility when reviewing pre-billing for established edits related to eligibility and for claims denied due to eligibility.
- Reviews all manuals, updates and reference guides to ensure that all proper guidelines are followed for each payer source.
- Once claim falls into your queue, correct any errors that are displayed.
- Enters hospital charges into the system. Accesses the hospital system to ensure correct insurance is being billed.
- Ensures that all hospital charge slips bear the proper CPT and ICD10 codes.
- Monitors all system reports to ensure timely filing requirements.
- Verifies correct PPS rate is received from Medicare and Medi-Cal. Verifies correct payment is received for all other insurance types. If payment received is same as the charge amount, notify Supervisor so charge can be adjusted if necessary.
- Follows procedures as outlined by the Supervisor/Manager to ensure correct claims processing for each payer source.
- Meets productivity goals established by Supervisor/Manager.
- Resolves complex billing issues. Informs Supervisor/Manager of any system problems or payer problems that prevent you from collecting the amount due for claims.
- Prints all necessary billing forms.
- Updates CPT codes and ICD10 codes on claims as appropriate.
- Posts all insurance payments. This will include manually inputting checks as well as processing electronic payments.
- Monitors private pay accounts. Follows established procedures. After final attempt to collect, adjust as bad debt.
- Posts all private pay payments received via the mail or from walk in patients.
- Follows up on Explanation of Benefits (EOBs) and Remittance Advice (RADs) from insurance companies where either no payment or only partial payment is received.
- Works insurance changes to financial classes sent to you by clinic staff. Updates and bills all accounts as necessary.
- Opens mail, distribute as appropriate, prepares log sheet of checks and prepares daily deposit.
- Assists Patient Accounts Manager and Supervisor with new procedures for special programs
- Answers patient informational requests (both in person and on the telephone).
- Collection activity to include write up of adjustment form.
- Establishes payment plans with patients
- Other duties as assigned by supervisor
- Maintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla Health
- Maintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actions
- Strives to learn more and is receptive to learning different ways of doing things
- Displays enthusiasm toward the work and the missions of Ampla Health
PROFESSIONAL KNOWLEDGE, SKILLS & ABLITIES
- Must have high school diploma or equivalent
- Ability to use Microsoft Word for basic correspondence
- Ability to type a minimum of 40 WPM
- Minimum of two years prior insurance billing experience, with knowledge of CPT Codes and ICD 10 Codes
- Knowledge of hospital and dental billing
- Knowledge of primary health care concepts
- Ability to adapt to specific environment and duties
- Must have neat and legible handwriting
- Must be able to interact with patients courteously and calmly
- Ability to communicate well with the public