Under supervision of the Manager of Patient Accounts and reporting to the same, this position is responsible for equitable resolution of assigned inventory. This individual carries out revenue computations with the purpose of billing for services rendered; performs third party and patient billing and follow up actions consistent with payor and Hospital criteria, analyzing and/or reconciling of reimbursements; and performing revenue, payment and/or adjustment transactions toward the resolution of accounts within their assigned inventory.
This position is a probationary position of six (6) months in which it is determined whether candidate is eligible to move into the permanent Patient Account Representative II position.
NATURE AND SCOPE:
Internal contacts include: Peers, administrative/medical/executive management, patients or their family members, and all members of the public fulfilling roles within Howard University Hospital or Howard University
External contacts include: All who submit and receive media or do business with Facility, government agencies, attorneys, claims reimbursement representatives, potential peers, contractors, patients or their family members.
Enters/Updates patient, insurance, contract, revenue and/or reimbursement data into one or more applications.
Prepares and submits hardcopy billing claim packages, including collecting of all necessary materials for proper claim creation/modification; making payor specific data changes as required for accurate and timely billing; Monitors subsequent payor processing and reimbursement performance to ensure agreement/contract compliance.
Effectively collaborates through verbal and written form of communication with patients and/or their family members, third party payors, or attorneys on matters involving billing and the pursuit of payment for services rendered.
Utilizes HUH payer contracts to effectively & efficiently calculate expected reimbursements.
Performs routine arithmetic calculations associated with revenue billing, computing expected payor and patient reimbursement amounts, as well as contractual adjustment amounts for individual accounts.
Establishes and/or monitors self-pay financial plans; working with vendors as necessary where patients may qualify for financial assistance.
Collaborates with Clinical Care or Social Work to obtain necessary materials for accurate and timely billing; or for the purpose of supporting denial prevention & management team.
Performs all necessary claim review and research to prevent claim delay as required for accurate and timely billing.
Reviews claims having incorrect or missing patient data, facilitates in the correction/addition of missing account data for the purpose of submitting an accurate and timely claim.
Reviews and corrects claim errors occurring on electronic claim scrubber system as defined by departmental guidelines.
Reviews and corrects all necessary items reflected in electronic billing/rejection reports or online claim status query results, delaying a third-party payor’s processing of claim(s).
Reviews and resolves credit balances accurately; Monitoring and reporting to immediate supervisors concerns with out-of-the-ordinary circumstances for investigation.
Performs payor remittance to reimbursement posting reconciliation and reimbursement posting corrections; ensuring reimbursement consistent with payor contractual/agreement terms before performing adjustments and/or billing of patient responsibility.
Performs manual posting of payments and necessary research when electronic posting is not applicable. (i.e. lock box, payment posting batch failures, unidentified payments.)
Receives and responds timely to internal/external phone calls, correspondence, and inquiries related to patient accounts.
Performs internal/external phone calls, drafts correspondence, and makes inquiries related to account(s) as required for accurate and timely billing.
Prepares and maintains supportive data and documents on all required activities within hospital system as defined by departmental guidelines.
Achieves appropriate Hospital performance, quality, and productivity standards as established.
The employee will perform other duties that further the customer service needs of the department, such as answering phones, greeting and escorting patients, and administrative and clerical duties upon request.
Assumes other duties and responsibilities that are related and appropriate to the position and area.
The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
Promotes adherence to the Health Sciences Compliance Program, the Howard University Code of Ethics and the Health Sciences Standards of Conduct.
Attends annual and periodic mandatory Compliance Program training including the Health Insurance Portability and Accountability Act (HIPAA) Privacy training.
Participates in activities that promote adherence to federal healthcare program requirements.
Actively participates in Health Sciences Compliance Program activities.
Adheres to the requirements of the HIPAA Privacy Policies and Procedures.
Maintains confidentiality of patients, families, and staff.
Ability to meet or exceed established productivity standards as defined by management and/or departmental guidelines.
Demonstrates the ability to consistently meet or exceed principle accountabilities required of this position.
Consistently demonstrates ability to produce accurate Medicare, Medicaid & Commercial payer claims that produce substantiated reimbursements.
Ability to assemble, analyze, comprehend, copy, record and/or transcribe data and/or information according to universal practices.
Knowledge of standard hospital organizational structure and roles departments play in day-to-day operations.
Ability to initiate an exchange of information for the purpose of obtaining information and clarification of details.
Ability to start, stop, operate and monitor the functioning of information systems, equipment, machinery, tools, and/or materials used in performing essential functions.
Ability to perform addition, subtraction, multiplication, and division individually and in conjunction with each other; Calculate decimals and percentages. Proficient in 10-key calculator.
Ability to carry out instructions furnished in written, oral and/or diagrammatic form, aptitude for deductive reasoning leading to predictable outcomes.
Ability to exercise the judgment, decisiveness and creativity in situations involving a variety of pre-defined duties which are often characterized by frequent change.
High proficiency in the use of Invision Unity Patient Management, Patient Accounts and EDM profiles, ePremis and Third Party Payor online resources.
Proficiency in the use of Microsoft Office programs including but not limited to: Outlook, Excel, Word, and Powerpoint.
Ability to work in a collaborative environment and think critically required.
Competence in both oral and written English.
Ability to establish and maintain effective and harmonious work relationships with staff, physicians, Hospital and University officials, and the general public
Must demonstrate collaboration; accountability; respect; excellence; and service.
Works with team members and peers in and outside of their immediate work group to create an exceptional experience for patients, students and other visitors; looks for ways to achieve departmental/institutional results by partnering.
Accepts responsibility for his/her actions to provide health care and or ancillary functions in a highly efficient and compassionate manner. The employees must function as a Steward (Have Ownership) of the Howard values that foster a commitment to improving the patient and student experience, organizational efficiency and environment.
Embraces diversity; cares holistically for those we serve; treats all as we would like to be treated; manages the patient’s right to privacy with meticulous care 100% of the time and keeps patient and proprietary information about the institution confidential.
Anticipates the patient’s and student’s needs, presents as a model representative of the institution and maintains high standards of care while striving to improve performance and create exceptional experience for our customers.
Behaves in a friendly, resourceful and professional manner towards all they encounter; treats patients, students and visitors in the same way that they would want their family members or themselves to be treated.
High School Diploma or General Equivalency Diploma (G.E.D).
Minimum of three (3) years of experience in any of the following areas: billing, collections, customer service, or cash posting required. Experience in hospital setting preferred.
Certified Revenue Cycle Specialist (CRCS-I (AAHAM)) or Certified Patient Account Representative (CPAR (HFMA)) certification preferred.
Must be able to work independently and manage time effectively, self-motivated, and detail-oriented.
Flexibility, organization, and problem-solving skills required.
Must be able to walk, sit, lift (12-25lbs) write, type, speak, hear, see, calculate, compare and evaluate for extended periods of time.