Patient Account Representative Lead - Pre-Visit Services/Authorizations

General Description: Under general supervision, may participate in any or all aspects of the patient processing and accounts receivable functions of the organization including billing, charge entry, collection, registration, scheduling, follow-up, coding, payment posting and credit balance resolution. May reconcile daily IDX system receivables reports. May balance monthly transactions and provide summaries to faculty and department administration.

Essential Responsibilities:

Patient scheduling

Patient registration

• Review patient admitting records and extracts relevant information

• Records patient identification and demographic information in the computerized billing system

• Contacts agency representatives to verify type and extent of coverage.

Charge entry

• Performs preliminary review of source documents to determine that sufficient data are present for processing

• Using alphanumeric keyboard, transcribes and/or verifies data from source documents to the medium used for entering data into the computer

• Batch charges

• Generate cash totals

• Enter charges

• Balances batches by comparing batch proofs to source documents and hash totals

Billing

• Works with all areas of the organization in getting any necessary or requested documentation for patients, insurance carriers or other areas.

• May interact with hospital patient accounting or records personnel to obtain patient demographic or other billing information

• Operates hospital information system terminal to obtain patient demographic information, patient insurance information and status of approvals or denials

• Completes processing of all inpatient and outpatient documents received on a daily basis

• Assists in resolving department problems with IDX billing

• Maintains records of charges, payments, third party charges, etc.

Collection

• Answers patient’s questions regarding statements, agency coverage, etc.

• Handles correspondence regarding collection activity and records results

• Identify patient accounts for collection action when accounts become delinquent or when unable to contact patient or responsible party

• May receive patient payments and/or issue payment receipts

Coding

• Record CPT codes on billing forms

• Record ICD-9 codes on billing forms

Follow-up

• Initiates contact with patients and/or third party carriers if there is a delay in responding to statements or claims

• May process incoming and outgoing mail

• May receive incoming telephone calls and resolve issues communicated

• Records results of mail and telephone contacts on the computer billing system

• Contacts insurance carriers regarding non-payment and/or improper payment of claims

• Reviews denials

• Interfaces with patients, physicians, and others regarding professional billing operations and funds

Payment posting

• Post receipts to proper patient accounts

• Posts denials

• Compare batch proofs and source documents for accuracy

Reporting

• Assists in reviewing and balancing IDX transaction reports for administration

• Reconciles daily IDX receivables reports

• Prepares billing statements from statistical data

Credit balance resolution

• Review daily billing and accounts receivable credit balance reports

• Prepare daily refund check requests

• Prepare other daily credit balances other than refunds

• Post refund checks to patient accounts

• Mail refund checks with supporting documentation

Personnel Supervision.

•  Leads and trains employees. 

General Responsibilities:

• Performs other duties as assigned.

Minimum Requirements:

Education: High School Diploma or GED.

Experience: At least 5 years of experience in Medical Billing, Medical Collections, Medical Billing Systems (IDX or other billing system) required.

Licensure/Registrations/Certifications Required: None required.

Knowledge, Skills & Abilities:

• Proven ability to manage a team of professionals and lead a departmental function

• Excellent verbal and written communication skills

• Proficient with the use of Microsoft Office tools