Patient Account Billing and Credit Balance Representative

Position Title: Patient Account Representative - Billing and Credit Balance

Grade: H

Department: Patient Accounting

QUALIFICATIONS:

REQUIRED TESTING:

Patient Accounting Terminology Test

Alpha-numeric data entry 4000

35 WPM

REQUIRED:

High School Diploma or GED

Two years recent medical billing and collection experience

One year experience with automated health care practice management systems

One year PC experience including Microsoft Office Suite

Knowledge of basic accounting principles

Working knowledge of insurance terminology, ICD, CPT, HCPCS and third-party billing and reimbursement procedures

Good communication skills, written and verbal, to establish and maintain effective working relationships, with internal/external payers and customers

Ability to work and make decisions independently, perform under deadlines and assume responsibility for problems and problem resolution

Must be detail oriented and have the ability to organize information

Must possess strong analytical and quantitative skills

Flexibility - must be able to perform team duties as required to accomplish departmental goals and meet patient customer needs

Ability to work well under pressure

Demonstrated ability to maintain confidentiality and handle sensitive and confidential information, per HIPAA and HealthPartners guidelines.

Demonstrated ability to adapt to new and different situations, read the behavior of others, have difficult conversations with ease, and defuses and resolves conflict.

Demonstrated knowledge of insurance and medical billing office terminology

PREFERRED:

Working knowledge of the following medical systems: Epic Resolute

Working knowledge of billing and reimbursement policies of two or more insurance payors.

PHYSICAL REQUIREMENTS:

Ability to see (vision). Normal manual dexterity. Must be able to speak, read, and write English fluently. Ability to sit for prolonged periods of time.

POSITION PURPOSE:

Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. The Patient Account Representative - Billing and Credit Balance is the primary link with the customer involving research, resolving and providing responses to patients, members, prospective members, HP personnel and third party payers on wide variety of subjects, including billing, coverage and services provided at HP. This position is accountable for accurate and timely resolution of claims and refunds, to include denial management, follow-up and third party collections.

ACCOUNTABILITIES:

Responsible for billing follow up/collection on assigned accounts with appropriate payers (i.e. governmental agencies, attorneys, patients, insurance companies) to ensure an acceptable level of outstanding receivables as defined by corporate or department key process measures based on national standards.

Appropriately respond to billing and credit questions from colleagues, peers, and third-party payers.

Negotiate with third-party payers and patients to resolve outstanding insurance balances successfully

Work with appropriate department/clinic/administrative staff to resolve or facilitate resolution regarding questions and/or issues related to billing, coding and denials.

Responsible for the understanding of insurance Coordination of Benefits and medical billing guidelines or laws.

Perform maintenance as needed on the patient's insurance record to ensure accurate billing.

Responsible for reading, understanding, and complying with all departmental and job-specific policies and procedures within the Department.

Responsible for follow up on account by performing necessary charge void and charge entry actions resulting from inquires or incorrect billings (i.e. coding, waiver, credits).

Re-issue claims and statements when necessary and resubmit to appropriate parties.

Responsible for knowing and understanding benefit structures provided and administered by HealthPartners, its subsidiaries, and insurance companies.

Identify and propose solutions to problems which contribute to customer dissatisfaction in order to reduce future complaints or errors.

Assist in orientation for new Patient Accounting staff. Operates as a member of Patient Accounting Team in support of other staff.

Completes assigned projects and duties in a timely manner.

Inform management/supervisor of deficiencies and erroneous items or codes in Resolute (billing system) master files.

Reviews and interprets payer remittances to determine appropriate action to be taken on denied claims, including an understanding of provider level adjustments (PLB).

Understand and comply with established workflows for corrected claims.

Submit insurance appeals with supporting documentation when warranted.

Identify when there is a need to appeal a refund request from a third party payer.

Compile and submit documentation for refunds due to patient and third-party payers when overpayments are requested or identified.

Work aged balances per assigned work direction/strategy outlined by management.

Coordinate with Coding and Billing personnel for correct and timely submission and/or resubmission of claims to third-party payers.

Post and reconcile both patient and insurance payments posted to set reconciliation methods as defined by management.

Produce and print demand claims as warranted.

Compare batch proofs and source documents for accuracy.

Contact third party payers to determine proper posting of payments as needed.

Resolve both undistributed and credit balance accounts while working from assigned worklist.

Research all aspects of the claim cycle to identify and correct errors which caused misappropriated funds.

Perform other duties as required to accomplish departmental goals and meet patient needs.