Central Account Representative

DEPARTMENT: Patient Financial Services
REPORTS TO: Patient Financial Services Supervisor
Summary:
 
The main focus of a Patient Account Representative is to ensure that United Health Centers is able to obtain payment from appropriate parties. In addition to ensuring that all billing and coding is accurate, timely and fraud free.
 
Summary of Responsibilities:
 
Works closely with the Patient Financial Services Supervisor and other members of the PFS Team to:
· Translate medical procedures into appropriate insurance billing codes.
· Enter accurate information into the practice management system.
· Produce statements and claims.
· Bill the insurance company for services performed and/or the patient for patient portion due.
· Collect correct insurance information from the patient and verify the patient’s benefits.
· Investigate unpaid accounts/claims within a timely manner.
· Maintain skills and knowledge of payer rules and guidelines in order to bill accurately.
 
1. PERFORMANCE AREA 1:
 
a. Prepares and submits clean claims to various insurance companies either electronically or by paper.
b. Answers questions from patients, clerical staff and insurance companies.
c. Identifies and resolves patient billing complaints.
d. Prepares and reviews patient statements.
e. Evaluates patient’s financial status and establishes budget payment plans.
f. Follows and reports status of delinquent accounts.
g. Reviews accounts for possible assignment and makes recommendations to the PFS Supervisor, and prepares information for the collection agency.
h. Provides daily production reports to PFS Supervisor.
i. Performs various collections actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
j. Processes payments from patients and prepares daily department deposit.
k. Participates in educational activities and attends monthly staff meetings.
l. Conducts self in accordance with UHC’s Employee Handbook.
m. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
 
2. PERFORMANCE AREA 2:
 
a. Supports PFS Department staff members in competing monthly task in a timely manner.
b. Assumes other assigned task as directed by the PFS Supervisor/Director.
3. PERFORMANCE AREA 3: General Corporate Expectations
a. Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
b. Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
c. Supports the overall needs of the health center by working flexible or extended hours when necessary.
d. Supports the needs of the health center by traveling to other UCH clinics when staffing needs dictate the need for licensed personnel.
e. Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.
f. Supports their own staff development by completing the required hours of continuing education each year.
g. Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
h. Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.
i. Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.
j. Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.
 
QUALIFICATION REQUIREMENTS:
 
EDUCATION
 
· High School Grad/GED
 
LICENSE/CERTIFICATION:
 
· Certified Professional Coder preferred but not required.
 
PRIOR EXPERIENCE:
 
· Minimum 2 years of experience in a healthcare setting, preferably in an FQHC setting
· Knowledge of medical, dental billing and collections practices.
 
SKILLS
 
· Bilingual (English/Spanish)
· Able to quickly build and maintain rapport with patients and providers of differing backgrounds; team player
· Customer-service oriented
· Strong computer skills
· Familiar with adult learning and general training techniques
· Positive professional insight
· Flexibility and dependability
· Demonstrated good problem-solving skills; sound judgment
· Skill in answering a telephone in a pleasant manner
· Modern office practices and procedures including email
· Attention to detail and excellent follow-through on work tasks
· Able to handle multiple tasks simultaneously
 
PHYSICAL REQUIREMENTS
 
· Must be able to lift up to 20 pounds and push up to 50 pounds (on wheels).
· Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to patients and staff.
· Must be able to read memos, computer screens, personnel forms and clinical and administrative documents.
· Must have high manual dexterity.
· Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn