LEAD PATIENT ACCOUNTS REPRESENTATIVE
POSITION SUMMARY
The Lead Patient Accounts Representative with an emphasis in Medicare billing is responsible for Medicare and back up for Medicaid and third party payor billing.
QUALIFICATIONS
Education:
High school diploma or GED.
Experience:
Three (3) years medical billing experience preferred; proficiency with a variety of computer software programs.
Additional Requirements:
May be required to work flexible hours and occasional overtime. Must have a personal cell phone.
PRIMARY RESPONSIBILITIES
Submits claims, electronically on a monthly basis to Medicare. Deaths and discharges are to be submitted bi-weekly once the timesheets have been approved.
Coordinates with billing staff to ensure the re-verification of Medicare eligibility and the benefit period, enters the information into Suncoast, and recalculates the benefit period (if applicable and lets the appropriate staff know) on the first business day after admission.
Ensures that Medicare Notices of Election (81A's) and Notices of Transfer (81C's) are submitted within the regulatory guidelines.
Generates and submits Medicare Secondary claims on a bi-weekly basis.
Follows any changes to a patient's account on a weekly basis by reviewing the event and audit report and communicating with the appropriate clinical team designee to ensure accurate billing for the accounts under their responsibility. Assists patient account representatives with issues they identify during the review of their patient's accounts.
Follows up bi-weekly on all assigned patient accounts over 30 days old.
Communicates with physicians' offices, hospitals, insurance companies, and other providers to obtain required information on patient billing sources on their assigned patient accounts and assists the other Patient Account Representatives when needed.
Takes call in the Finance Department on a rotating schedule to verify patient's eligibility, Medicare benefit period, and notification of Face to Face visit if applicable.
Runs the physician report for payroll purposes.
Prior to billing at the end of the month, runs the Contracted and Additional Services Report and makes corrections as needed (i.e. gross rate pulls for third party payors, net rate pulls for Medicaid and Medicaid).
Generates the unbilled claims report at the end of the month for month end close.
Entering physician visits into the patient accounting system when receiving physician billing sheets.
Backs up the Patient Accounts Representative specializing in Medicaid, Private Insurance Billing, and Nursing Home billing.
Assists Patient Accounts Manager with running end of month reports needed for the financial statements.
Responsible for generating Nursing Home invoices quarterly to maintain working knowledge of all applicable systems and regulations.
Training and education of Patient Accounts Representatives and Commercial Insurance Liaison.
Oversees and ensures timely monthly statements to private pay patients.
Assists staff when necessary in advising patients and their families concerning their financial responsibility.
Assists the Finance Director, and Patient Accounts Manager as requested; assists with other office functions as required.
Handles confidential material with tact, diplomacy and discretion.
Maintains strict confidentiality at all times.
Utilizes and models excellent customer service skills at all times; seeks opportunities to assist patients, families and co-workers; demonstrates teamwork and cooperation.
Accepts direction and follows instructions from supervisor; seeks additional information as needed; works with minimal supervision.
Adheres to all organizational and departmental policies and procedures.
Continually meets organizational standards for attendance and punctuality; notifies supervisor in a timely manner when employee will be absent or late for work.
Attends all required meetings and inservices; seeks opportunities for additional professional development activities as appropriate.
COMPETENCIES, KNOWLEDGE, SKILLS, AND ABILITIES
THIS SECTION DESCRIBES WHAT KNOWLEDGE, SKILLS AND ABILITIES AN EMPLOYEE IN THIS POSITION SHOULD CURRENTLY POSSESS. THIS LIST MAY NOT BE COMPLETE FOR ALL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION.
Ability to communicate effectively both orally and in writing.
Ability to communicate effectively with co-workers and other customers.
Ability to follow basic safety policies and procedures.
Ability to use good judgment and to maintain confidentiality of information.
Ability to work as a team player.
Ability to demonstrate tact, resourcefulness, patience and dedication.
Ability to accept direction and adhere to policies and procedures.
Ability to work in a fast-paced environment.
Estimated Salary: $20 to $28 per hour based on qualifications.
The Lead Patient Accounts Representative with an emphasis in Medicare billing is responsible for Medicare and back up for Medicaid and third party payor billing.
QUALIFICATIONS
Education:
High school diploma or GED.
Experience:
Three (3) years medical billing experience preferred; proficiency with a variety of computer software programs.
Additional Requirements:
May be required to work flexible hours and occasional overtime. Must have a personal cell phone.
PRIMARY RESPONSIBILITIES
Submits claims, electronically on a monthly basis to Medicare. Deaths and discharges are to be submitted bi-weekly once the timesheets have been approved.
Coordinates with billing staff to ensure the re-verification of Medicare eligibility and the benefit period, enters the information into Suncoast, and recalculates the benefit period (if applicable and lets the appropriate staff know) on the first business day after admission.
Ensures that Medicare Notices of Election (81A's) and Notices of Transfer (81C's) are submitted within the regulatory guidelines.
Generates and submits Medicare Secondary claims on a bi-weekly basis.
Follows any changes to a patient's account on a weekly basis by reviewing the event and audit report and communicating with the appropriate clinical team designee to ensure accurate billing for the accounts under their responsibility. Assists patient account representatives with issues they identify during the review of their patient's accounts.
Follows up bi-weekly on all assigned patient accounts over 30 days old.
Communicates with physicians' offices, hospitals, insurance companies, and other providers to obtain required information on patient billing sources on their assigned patient accounts and assists the other Patient Account Representatives when needed.
Takes call in the Finance Department on a rotating schedule to verify patient's eligibility, Medicare benefit period, and notification of Face to Face visit if applicable.
Runs the physician report for payroll purposes.
Prior to billing at the end of the month, runs the Contracted and Additional Services Report and makes corrections as needed (i.e. gross rate pulls for third party payors, net rate pulls for Medicaid and Medicaid).
Generates the unbilled claims report at the end of the month for month end close.
Entering physician visits into the patient accounting system when receiving physician billing sheets.
Backs up the Patient Accounts Representative specializing in Medicaid, Private Insurance Billing, and Nursing Home billing.
Assists Patient Accounts Manager with running end of month reports needed for the financial statements.
Responsible for generating Nursing Home invoices quarterly to maintain working knowledge of all applicable systems and regulations.
Training and education of Patient Accounts Representatives and Commercial Insurance Liaison.
Oversees and ensures timely monthly statements to private pay patients.
Assists staff when necessary in advising patients and their families concerning their financial responsibility.
Assists the Finance Director, and Patient Accounts Manager as requested; assists with other office functions as required.
Handles confidential material with tact, diplomacy and discretion.
Maintains strict confidentiality at all times.
Utilizes and models excellent customer service skills at all times; seeks opportunities to assist patients, families and co-workers; demonstrates teamwork and cooperation.
Accepts direction and follows instructions from supervisor; seeks additional information as needed; works with minimal supervision.
Adheres to all organizational and departmental policies and procedures.
Continually meets organizational standards for attendance and punctuality; notifies supervisor in a timely manner when employee will be absent or late for work.
Attends all required meetings and inservices; seeks opportunities for additional professional development activities as appropriate.
COMPETENCIES, KNOWLEDGE, SKILLS, AND ABILITIES
THIS SECTION DESCRIBES WHAT KNOWLEDGE, SKILLS AND ABILITIES AN EMPLOYEE IN THIS POSITION SHOULD CURRENTLY POSSESS. THIS LIST MAY NOT BE COMPLETE FOR ALL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION.
Ability to communicate effectively both orally and in writing.
Ability to communicate effectively with co-workers and other customers.
Ability to follow basic safety policies and procedures.
Ability to use good judgment and to maintain confidentiality of information.
Ability to work as a team player.
Ability to demonstrate tact, resourcefulness, patience and dedication.
Ability to accept direction and adhere to policies and procedures.
Ability to work in a fast-paced environment.
Estimated Salary: $20 to $28 per hour based on qualifications.
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