Under the direct supervision of the Physician Reimbursement Supervisor, the Lead Patient Accounts Representative works in the Professional Billing Office (PBO) providing continuous support and education to our internal and external teams in regards to collections, adjustments, appeals, remittance review, etc. This will include review and working accounts alongside team members as well as reviewing adjustments and refund requests for approval. Communication of account details, payer issues, and other ongoing concerns affecting collections to management is required.
The Lead Patient Accounts Representative serves as a main resource for assisting support staff with billing related services and acts as a subject matter expert for workflow related questions/concerns. Responsible for escalating issues to the Supervisor of Patient Accounts as needed for assistance in resolution. The incumbent is also expected to function as a Patient Accounts Representatives and/or other assignments delegated by management.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
Lead Patient Accounts Representative Responsibilities:
- Functions as a primary resource for questions and project related matters.
- Assists in furthering the development of the physician reimbursement team by setting the tone for the team's work ethic, efficiency, proficiency, and professionalism. Presents to medium-large audiences regarding revenue cycle workflows and upgrades in various systems.
- Exhibits Proficient Use of EPIC System: Efficient utilization of and training on the billing system database to update facility file and patient demographic information; ability to edit a claim and send/receive claim notes in the billing system. Ability to fully train on and work all work queues.
- Competence with Insurance Issues: Demonstrated ability to post charges, payments, adjustments, and knows how to work undistributed payments. Understands claims overpayments, collections, and pre-bill/post-bill work queues. Possesses competency of medical coding knowledge. Demonstrates the ability to train on the processes. Serves as a payer liaison to streamline communication of policy updates and revisions to staff
- Organizational Efficiency: Effectively maintains follow up account activity by ensuring the proper organization, time management, tracking, resolution, and documentation of all correspondence. Facilitates workflow for accounts receivable and claims submission. Reviews denials and accounts deemed uncollectible by Primary Billing Team staff. Recommends additional steps to prevent losses or determines account collectible, selects appropriate adjustment code for denial tracking and resolution. Immediately alerts department leadership to new or emerging trends in denials.
- Able to serve as a cross functional resource to our Customer Service, Revenue Integrity and Cash Operations Teams.
- Responsible for special projects assigned by Physician Reimbursement Supervisor and/or Physician Reimbursement Manager.
- Assists with training and onboarding of all new staff and does special projects as assigned by management.
- Reports metrics, trends to Physician Reimbursement Supervisor promptly.
- Works with Supervisory and Revenue Integrity teams to adapt and revise Standard Operating Procedures and Training Workflows.
- High School Diploma or equivalent (GED) required.
- Excellent interpersonal and communication skills.
- The ability to work collaboratively in a team setting as well as external and internal departments.
- Three or more years of experience in professional billing and or revenue cycle operations.
- Proficient in teaching and providing appropriate feedback.
- Highly organized, detail oriented and flexible, ability to re prioritize work, adapt to new processes timely.
- EPIC system experience preferred
- Technical Medical Billing Coding certification preferred.
- Five plus years of billing experience including ICD-10, CPT/HCPCS coding and medical terminology.
- Experience in operating multi-line phone system, fax/copier/scanner and credit card machines.
- Ability to operate a PC efficiently and type at least 40 wpm.
- Must be able to sit, stand, lift, bend and move intermittently during work hours.
- Must be available Monday through Friday during normal business office hours.
- Must have the ability to stand for long periods of time.
- Must be able to effectively communicate in the English language written and verbally.
- Must have the capacity to work in an organized, independent manner, and be able to make good judgmental decisions.
- Must display a professional and courteous disposition and an ability to communicate well.
- Must have a neat clean and professional appearance. Business attire required at all times.
- Illustrates the ability to utilize Microsoft Office and/or Google Suites. Outlook email and navigate in the Word & Excel software applications.
- Experience and knowledge in overall claims processing and insurance follow up collections preferred in a health care institution or multiple physician practice shared services environment.
- Experience should encompass at least three different professional billing service specialties
- Intermediate Microsoft Excel skills including ability to create formulas, pivot tables and perform v-lookups independently is preferred.
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands -
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.