Patient Account Representatives must be skilled in problem resolution. He or she must represent the practice in the manner consistent with the best of patient care while initiating the collections and insurance reporting process. Patients form lasting impressions of the office from the skills this person exhibits.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
• Mails statements to patients to encourage payment of delinquent accounts.
• Confers with patient or insurance company by telephone in attempt to determine reason for the outstanding balance.
• Obtains PreCert information from PreCert department. Then must contact patient to collect physician charges prior to the day of the surgery. Also relays facility charges that will be due the day of the surgery to be paid to Piedmont Eye.
• Responds to patient or insurance company phone calls within 24 hours, but preferably same day.
• Turns delinquent accounts over to collections.
• Files insurance claims. Once the PAR receives the claims he/she should check the claims to make sure all the information is correct and then send it to the proper insurance company.
• Answer insurance correspondence. Comes on a daily basis about claims that have been filed and more information is needed or the claim is being denied by the carrier. It is very important that a response is sent quickly so that payment is received in a timely manner.
• On a daily basis each PAR receives EOB's from accounts receivable. In addition EOB's are to be printed off daily from Navicure. It is the PAR's responsibility to input adjustments into the system. **no greater than the amount set by your supervisor. Any adjustments above set amount are to be forwarded to the proper physician for approval.* PAR's should review each EOB to see if the claim needs a refund, appeal, further adjustment*, or any rebills to additional insurance policies.
• In review of a patient account, each PAR should determine if a refund is due to the patient or the insurance company. He/she should write this amount on a "refund request" and submit to the Accounts Payable department with a detailed description. The system should also be noted to any refund requests made.
• Each PAR will print and review Insurance and Patient AR once a month. The PAR is to work each account individually and follow through with whatever means necessary to assure prompt payment is received. Methods to do so include but are not restricted to; rebilling, correcting patient demographics, insurance information and submitting additional information.
• PAR's will receive charges (surgical or office) to be entered. These charges must be entered within 24 hours of receipt.
• Check Navicure daily for reports on any rejections.
• Back up for all front desk positions (check in, check out and appointments).
• Excellent computer skills mandatory. Ability to read and problem solve from AR ledgers.
• Basic accounting skills necessary.
• Ability to work cheerfully under mental stress.
• Ability to diffuse the angry patient without adding to the problem and work toward problem resolution.
• Pleasant personality and courteous manner.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
• High school diploma or general education degree (GED); and/or at least one year experience in the medical field, preferably in collections.
• Ability to read and comprehend simple instructions, short correspondence and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
• The ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio and percent and to draw and interpret bar graphs.
• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
CERTIFICATES, LICENSES, REGISTRATIONS
• Current driver's license.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.