Patient Account Representative Customer Service, FT Days

Business Services:

Patient Account Representative Medicare Billing & Follow Up:

Under the supervision of the Insurance Billing Manager, this position is responsible for the timely and accurate billing and follow-up of unpaid Medicare inpatient and outpatient accounts.  This includes identification and processing of appropriate write-offs, accurate resolution of all credit balances and prompt response to help letters.  Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

Patient Account Representative Commercial Insurance Follow Up, Patient Account Representative -(Quality Review/Vendor Liaison non-Certified):

Under the supervision of the Commercial Supervisor, this position is responsible for the timely and accurate follow up of Commercial and Government HMO insurance Accounts Receivable, submitting appeals, and reporting issues. The Patient Account Representative will interpret contracts to calculate expected reimbursement, identifying additionally reimbursed contract carve outs, and submit appropriate contractual adjustments and write-offs. The position will have minimum productivity volume and standards of work to meet as defined within the departmental policies and procedures.

Patient Account Representative - Medicare COB, MSP:

This position under the supervision of the Government Billing Manager, this position is responsible for the timely and accurate follow-up of unpaid Medicare inpatient and outpatient accounts for issues related to coordination of benefits or Medicare as secondary, or primary related denials. This includes identification and processing of appropriate MSP guidelines, follow up with patient, employers and health insurance carriers for coordination of benefits, accurate and timely resolution of outstanding COB, MSP related issues.  Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

Patient Account Representative Non-Certified-Cashier:

Under the supervision of the Collection/Customer Service Manager, this position is responsible for assisting patients with making payment arrangements, mailing out charity applications and reviewing bank deposits for the hospital cashiering department.  Complies to AB774 and all applicable federal and state laws and regulations.

Patient Account Representative Commercial Insurance Biller Non-Certified:

Under the supervision of the Billing Manager, this position is responsible for the timely and accurate billing of commercial and group insurance inpatient and outpatient accounts. This includes the pre-billing, billing and electronic submission of hospital claims; identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, identification of stop loss claims and “carve out” items that are reimbursed at different rates.  Ensures compliance to the payer’s contracted billing requirements.  Performs timely billing of commercial or group secondary insurance.  Coordinates with the Medicare and Medi-Cal team for any MSP issues, HMO acknowledgements or Medicare/Medi-Cal as secondary billing. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

Patient Account Representative Commercial Insurance Follow Up Non-Certified on-call: 

Under the supervision of the Insurance Billing Manager, this position is responsible for the timely and accurate follow up of Commercial and Government HMO insurance Accounts Receivable. This consists of contacting the appropriate responsible payer for the status of submitted claim(s) and resolution of delays in payment or underpayments of the contracted amount due to Presbyterian Intercommunity Hospital for its services rendered.  Responsible for interpreting contracts to calculate expected reimbursement, identifying additionally reimbursed contract carve outs, and submitting appropriate contractual adjustments and write-offs.

Commercial Tracer and Medical Records Representative Non-Certified:  

Under the supervision of the EOB, Refund Manager, this position is responsible for the timely and accurate review and status of   claims submitted to payers within a time frame of 30-60 days following initial billing. This consists of confirming with payers receipt of claims, ensuring timely processing, detection and trending of payer payment delays, and determining the appropriate protocols needed to resolve existing account balances for expedited resolution of the contracted amount due Presbyterian Intercommunity Hospital for its services rendered.  Responsible for identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, use of the contracts to determine accurate expected reimbursement. This role is responsible for the overall Medical Record process which includes: submitting requests to Health Information Management department, ensuring that records are logged and forwarded to requestor.

Patient Account Representative EOB Review Non-Certified:

Under the supervision of the EOB, Refund Manager , this position is responsible for the timely and accurate review of commercial and group insurance inpatient and outpatient payor correspondence, EOB’s.  This consists of reviewing the received payer correspondence for the accurate payment of the contracted amount due Presbyterian Intercommunity Hospital for its services rendered.  Responsible for identification and processing of appropriate write-offs, accurate use of HMO matrix to identify responsible payer, use of the contract data base to determine accurate expected reimbursement and the identification of stop loss claims and “carve out” items reimbursed that are reimbursed at different rates.  Monitors payors to identify underpayment trends/issues and notifies management.  Forwards correspondence, as necessary, to appropriate patient account representative for additional review, if needed.  Initiates appeals of claims for inappropriate denials or underpayments.  Reviews correspondence no later than three business days from receipt.  

Patient Account Representative Medi-Cal Biller/Follow up Non-Certified:

Under the supervision of the Patient Accounting Director, this position is responsible for the timely and accurate billing through resolution of Medi-Cal inpatient and outpatient accounts. This includes billing, collection and follow-up activities; identification and processing of appropriate write-offs, accurate resolution of all credit balances and prompt response to communications from Medi-Cal.  Ensures compliance to Medi-Cal billing requirements to include all coding edits.  Performs timely billing of Medi-Cal as a secondary insurance to Medicare Part B and Commercial Insurance. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

Patient Account Representative Medicare Biller:

Under the supervision of the Billing Manager, this position is responsible for the timely and accurate billing of Medicare inpatient and outpatient accounts. Understands and complies to CMS billing requirements to include all coding edits.  Performs timely billing of secondary insurance and follow up on unpaid balances due from secondary payers. Meet and exceed the minimum productivity volume, and standards of work as defined within the departmental policies and procedures.

Refunds Processing Representative Non-certified: 

Under the supervision of the EOB, Refund Manager this position reviews, investigates and resolves all assigned credit balance accounts in accordance to all federal, state and contractual mandates.  The refunds are completed in a timely and accurate manner.  Identifies and reports to departmental management of issues that result in credit balances.   Submits corrective adjustments to ensure credit balances are resolved.

Patient Account Representative Customer Service Non-certified:

Under the supervision of the Collections/Customer Service Manager, review unpaid hospital claims for patient accounts and use procedural guidelines to reduce the outstanding dollars on accounts receivable.  Ensure incoming correspondence and inbound telephone calls are reviewed and answered in a timely manner.  Accurately determine patient status, insurance coverage and billing information.  Review accounts for write off to bad debt.  Receive and update patient information. 

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work ^TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

Business Services:

Demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC).Ability to perform multiple tasks, good mathematical skills, sound decision making abilities and good verbal and written communication skills.

Patient Account Representative Medicare Billing & Follow Up, Patient Account Representative - Medicare COB, MSP:

• Excellent verbal and written communication skills demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC). 
• Ability to perform multiple tasks, good mathematical skills, sound decision making abilities and good verbal and written communication skills.
• Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided, proficient in excel and word document for appeal submission to payers.

Patient Account Representative Commercial Insurance Follow Up, Patient Account Representative -(Quality Review/Vendor Liaison non-Certified):

• Excellent verbal and written communication skills.
• General office equipment and computer skills, including 10-key and scanners.
• Good mathematical skills
• Proficient in word processing and spreadsheet applications.

Patient Account Representative Non-Certified-Cashier:

• Ability to use a 10-key adding machine, calculator, FAX machine, CRT for data entry and a personal computer (PC).  Personal computer (PC) experience desirable. 
• Ability to perform multiple tasks, good mathematical skills, sound decision making abilities, and good verbal and written communication skills.
• Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided, proficient in excel and word document.

Patient Account Representative Commercial Insurance Biller Non-Certified:

• Demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC). 
• Ability to perform multiple tasks, good mathematical skills, sound decision making abilities and good verbal and written communication skills.
• Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided, proficient in excel and word document.

Patient Account Representative Commercial Insurance Follow Up Non-Certified on-call: 

• Demonstrated ability to utilize personal computer, 10-key adding machine, calculator, fax machine, copier and scanners.
• Able to multi-task, good mathematical skills, excellent verbal and written communication skills, sound decision making. 
• Ability to learn.

Commercial Tracer and Medical Records Representative Non-Certified, Patient Account Representative EOB Review Non-Certified, :

• Demonstrated ability to utilize personal computer, 10-key adding machine, calculator, fax machine, copier and scanners.
• Able to multi-task, good mathematical skills,  excellent verbal and written communication skills, sound decision making. 
• Ability to learn new systems, and extract data from hospital systems. 
• Proficient in Microsoft Excel and Word.

Patient Account Representative Medi-Cal Biller/Follow up Non-Certified, Patient Account Representative Medicare Biller, Refunds Processing Representative Non-certified: 

• Demonstrated ability to use a 10-key adding machine, calculator, fax machine, photocopy machine keyboard for data entry and personal computer (PC). 
• Ability to perform multiple tasks, good mathematical skills, sound decision making abilities and good verbal and written communication skills.
• Ability to learn new systems, become proficient in development of  reports via hospital systems and tools provided, proficient in excel and word document for appeal submission to payers

Patient Account Representative Customer Service Non-certified:

• Excellent verbal and written communication skills
• Proficient in Windows, Microsoft Word, Excel, and Mail Merge
• Minimum typing speed of 55 wpm.
• Excellent organizational skills.
• Can operate office equipment i.e., printer, fax, etc.

Required Experience

Business Services:

Required:

• High school graduate

Preferred:

Two years college preferred.Minimum two years of hospital billing and follow up required.Knowledge of hospital billing requirements and regulations. Knowledge of Commercial, Senior Managed Care or group insurance billing requirements and regulations. Evidence of continuing education preferred.Understanding of CMS rules and regulations concerning of accurate claims submission. Ability to learn new systems, become proficient in development of reports via hospital systems and tools provided, proficient in excel and word document.

Patient Account Representative Medicare Billing & Follow Up:

Required:

• High School Diploma or G.E.D is required or [10] years of experience is required. 

Preferred:

• Two years college preferred. 
• Minimum two years in hospital Medicare billing and follow up required. 
• Knowledge of CMS billing requirements and regulations.
• Evidence of continuing education preferred. 
• Familiarity with commercial third-party billing requirements.

Patient Account Representative Commercial Insurance Follow Up, Patient Account Representative -(Quality Review/Vendor Liaison non-Certified):

Required:

• Minimum two years' experience in hospital commercial follow up and/or billing
• Understanding of Medicare CMS rules and regulations related to accurate claims submission.
• Knowledge of insurance and government billing guidelines and regulations. 

Preferred:

• High school graduate.
• Two years college.

Patient Account Representative - Medicare COB, MSP:

• High school graduate preferred. 
• Two years college preferred. 
• Minimum two years in hospital with basic Medicare billing and follow up knowledge required. 
• Knowledge of MSP, ESRD and health insurance COB billing requirements and regulations.
• Evidence of continuing education preferred. Familiarity with commercial third-party billing requirements

Patient Account Representative Non-Certified-Cashier:

• High school graduate preferred. 
• Two years junior/community college preferred. 
• Must have at least two years of hospital billing and/or collection experience. 
• Should be familiar with all third party billing.  Knowledge of medical terminology, AB774 and Fair Debt Collection Act.  Bilingual helpful. 
• Must be able to handle self in a mature, dependable, conscientious and honest manner.

Patient Account Representative Commercial Insurance Biller Non-Certified:

• High school graduate preferred. 
• Two years college preferred. 
• Minimum two years in hospital commercial and group insurance billing and follow up required. 
• Knowledge of commercial or group insurance billing requirements and regulations.
• Evidence of continuing education preferred. 
• Understanding of CMS rules and regulations concerning of accurate claims submission.

Patient Account Representative Commercial Insurance Follow Up Non-Certified on-call: 

• High school graduate preferred. 
• Two years college preferred. 
• Minimum of two years experience in hospital Commercial Follow up and/or Billing required. 
• Knowledge of Insurance and Government Billing guidelines and regulations.
• CPAT certified.
• Evidence of continuing education preferred. 
• Understanding of Medicare CMS rules and regulations related to accurate claims submission.

Commercial Tracer and Medical Records Representative Non-Certified, Patient Account Representative EOB Review Non-Certified:

• High school graduate preferred. 
• Two years college preferred. 
• Minimum two years in hospital commercial and group insurance billing and follow up required. 
• Knowledge of commercial or group insurance billing requirements and regulations.
• Knowledge of Medicare and Medical regulations.
• Knowledge of Coordination of Benefits. 
• Evidence of continuing education preferred. 

Patient Account Representative Medi-Cal Biller/Follow up Non-Certified, Patient Account Representative Medicare Biller:

• High school graduate preferred. 
• Two years college preferred. 
• Minimum two years in hospital Medi-Cal billing and follow up required. 
• Knowledge of Medi-Cal billing requirements and regulations.
• Evidence of continuing education preferred. 
• Familiarity with commercial third party billing requirements

Refunds Processing Representative Non-certified: 

• High school graduate preferred. 
• Two years college preferred. 
• Minimum of two years' experience in hospital Commercial Follow up and/or Billing required. 
• Knowledge of Insurance and Government Billing guidelines and regulations.
• Must demonstrate a full understanding of third-party reimbursement practices and protocols to include HMO/PPO, indemnity, Medicare and Medi-Cal.  
• Ability to analyze and calculate expected reimbursement. 
• Excellent written and verbal communication skills. 
• Medical terminology.

Patient Account Representative Medicare Biller:

• College degree preferred, two years college required or medical billing certification. 
• Minimum one year in home health Medicare billing and follow up required. 
• Knowledge of CMS billing requirements and regulations. 
• Familiarity with commercial third party billing requirements.

Patient Account Representative Customer Service Non-certified:

Required:

• Formal training will be indicated by a high school diploma or equivalent
• Two years previous clerical/secretarial experience
• Professional working manner with excellent phone etiquette and strong customer service orientation.
• Experience answering multi-line inbound calls
• Microsoft Word, Excel and Outlook proficiency. 

Preferred:

• Medical terminology preferred
• Knowledge of AB774 and Fair Debt Collection Act.