FISHERMEN’S COMMUNITY HOSPITAL

MARATHON, FLORIDA

TITLE:           Patient Account Representative Billing/Collections 

PURPOSE: To ensure accurate and timely submission of insurance claims via electronic or hard copy

mail in claims; responsible for reviewing, editing and transmitting or submitting all

necessary UB-04’s and/or HCFA 1500’s.  Must also submit all appropriate associated

documentation. Processes all statements on in-house and discharged patients.

Maintains follow-up and collections activity including letters, telephone and personal

contact.  Maintains patient financial file and documentation, advises, informs and assists

the patient/guarantor/family in regards to facility financial policies.  Performs other

various clerical responsibilities as may be assigned. 

JOB RELATIONSHIPS:

A.        Responsible to the Business Office Manager (BOM).

B. Supervises no other employees, assists the Financial Counselor position, Cashier and Admissions.  Business hours rotating shifts 8am-4:30pm, 9am-5:00pm and/or 10am-6pm including weekends. 

C. Inter-relationships with patients, patient families, third party payers, registration staff, file clerks and other departments.  Other duties assigned by the Business Office Manager.

ESSENTIAL FUNCTIONS:

1.         Electronically submits all inpatient and outpatient insurance claims to Medicare, Medicaid, Commercial Insurance, Secondary Insurances and other duties assigned by the BOM.

1:1       Ensures that all insurance claims information is correct including revenue codes, CPT codes, doctor information and charges, before submitting the claim, with only three errors per month.

1:2       Edits all claims with errors, before resubmitting claims electronically.

1:3       Documents pertinent information in computer system about claim submission.

2.         Researches and processes all refunds promptly.

2:1       Reviews Medicare, Medicaid and commercial credit balance accounts daily, identifying and correcting all overpayments.

2:2       Completes and submits Medicare credit balance report quarterly.

2:3       Reviews all insurances for accuracy and completes bad debt write-off spreadsheet monthly.

3.         Files hard copy claims on all inpatients and outpatients to all insurances as required for adjusted claims.

3:1       Ensures that all inpatient and outpatient claims are signed, dated, and billed the day received with no more than 5\% error per month.

3:2       Ensures that all corrections to type of bill, financial class, etc. are made prior to mailing.

3:3       Updates insurance status on screen to show the bill has been resubmitted.  Documents all relevant information regarding the resubmission of the claim in the computer system.

3:4       Ensures all bills on the unbilled report have been billed daily.

4.         Files all secondary insurance claims to Medicare and Medicaid.

4:1       Ensures that all Medicare and Medicaid secondary claims are filed daily.

4:2       Updates insurance status on screen to show the bill has been submitted.

4:3       Ensures that all claims billed to secondary are placed in proper secondary financial class.

5.         Conducts follow-up activity of patient accounts through weekly follow-up lists.

5:1       Ensures timely and accurate follow-up bi-monthly on accounts with balances over $20,000 and monthly on accounts with balances less than $20,000, 30 days after discharge.

5:2       Documents all account follow-up thoroughly, including person contacted and expected payment amount and date.  Uses \"Review Dates\" to facilitate further collection activities.

6.         Performs other duties, as assigned, in a professional and cooperative manner.

6:1       Reviews and responds to correspondence within 48 hours of receipt.

6:2       Acts as relief Cashier, Admitting Clerk, or other business office personnel as needed in a cooperative and professional manner.

7.         Adheres to and follows the principles of Fishermen’s Community Hospital’s Quality Customer Relations Program.

7:1       Promotes quality guest relations by identifying both internal and external customers promptly; and, using expressions that express respect, understanding, and enhance self esteem.

7:2       Creates a positive impression through effective use of telephone skills, such as answering the phone by the third ring, identification of self and department, listening attentively, personalizing the conversation and verifying information.

7:3       Creates a supportive climate for customers by allowing customers to express themselves, addressing their concerns as being real and encouraging two way communication.

7:4       Promotes therapeutic interactions with customers by identifying behaviors resulting from dissatisfaction, then, allowing customers to respond openly, showing empathy and discussing options.

QUALIFICATIONS: 

Education:

High school graduate of equivalent required.  At least two years of college preferred.

Experience:

One-year experience as an insurance clerk in a hospital or physician\'s office preferred.  Experience with automated systems preferred.  Knowledge of claims submission process for all major insurance carriers, intermediaries, Medicare and Medicaid preferred.

Administrative Skills:

Computer Skills

Input data into computer programs, Microsoft Word and Excel knowledge preferred

Communication Skills

Answer Telephones and Compose Letters

General Office Skills

Balance figures, Compile statistics & Research information

Equipment, Machine & Tools Used:

Computer Equipment & General Office Equipment

Personal Computer & Computer Peripheral Equipment

Calculator, Fax, Photocopier, Scanning, Credit Card Terminals

WORKING ENVIRONMENT:

Working Conditions:

Subject to varying and unpredictable situations and subject to many interruptions.

Occasionally subjected to irregular hours and pressure due to multiple calls and inquiries.

Handles absentee replacement on short notice.

PHYSICAL DEMANDS: Using the percentage range as listed:

0\% = Never     1 - 33\% = Occasional    34 - 66\% = Frequent     67 - 100\% = Continuous

Requires full range of body motion including:

1.         Sitting: Continuous.  Worker is seated the majority of the day at a desk using a computer.

2.         Stand/Walk: Frequent.  Worker is on his/her feet doing various tasks such as making copies, checking medical records, pulling patient financial packets and consulting with the chart auditor.

3.         Bend/Squat/Crouch/Kneel: Occasional.  Worker must be able to bend/squat/crouch/kneel to perform such tasks as picking up boxes, loading printer paper, or opening bottom drawers on file cabinets.

4.         Climb: Occasional.  Shorter workers must be able to reach the top of file cabinets by standing on step stool.

5.         Reach: Occasional.

A. Greater than shoulder height - Worker must be able to reach supplies or items on shelf that is greater than shoulder height.

B.         Equal to shoulder height - Worker must be able to reach supplies or items that are of a level that is equal to shoulder height.

C.        Less than shoulder height - Worker must be able to reach supplies or items that are below shoulder height.

6.         Push/Pull: Occasional.  Worker must be able to push/pull up to 20 pounds.  Worker must be able to push/pull boxes and file cabinet drawers.

7.         Verbal Communication: Continuous.  It is very important that worker must be able to verbally communicate with the patient in order to obtain demographic and financial information necessary to complete the billing process.  Worker must also be able to verbally communicate with co-workers, physicians, visitors and insurance companies.

8.         Written Communication: Continuous.  Worker must be able to correspond in writing with insurance companies, write messages for employees, and correspond in writing to various departments within the hospital.

9.         Hearing Conversation: Continuous.  It is imperative that worker must be able to hear patients in order to obtain the correct information. Worker must be able to hear co-workers to communicate within the office and hospital.

10.       Seeing - Near/Far -With or Without Accommodation-Color-Depth: Continuous.  Worker must be able to see to perform computer tasks, file insurance, and document patient financial packets.  Workers must be able to hear co-worker to communicate within the office and hospital.

11.       Simple Grasp Left/Right:  Continuous.  Worker must be able to pick up file folders, admission papers and insurance correspondence.

12.       Fine Manipulation: Continuous.  Worker must be able to use the keyboard of a computer and calculator.

13.       Lift: Occasional.  Worker must be able to lift up to 25 pounds in order to move boxes of computer paper, insurance forms, storage boxes and boxes of mail.