DSS Patient Account Rep. I at Deaconess Health System – Evansville, Indiana

SUMMARY OF THE JOB
• This position is responsible for accurate charging, billing, follow-up, refunding, contract variance follow-up, and posting of insurance and self pay accounts for Hospital Billing, Professional Billing, and Comp Center Billing. Responsible for the resolution of patient inquiries pertaining to billing and insurance filing processes. Will work with patients and third party payors to obtain payment on delinquent accounts according to the legal and proper collection techniques as well as maintain accounts receivable goals developed by the department.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
• Job Duties include the following, other duties may be assigned:
o Mailroom:
 Daily processing of the incoming postal and inner office mail completed by the end of the normal work day. Carry over is permitted based on large volume of incoming mail.
 Prepare paper checks/ no pay batches according to policy.
 Prepare EFT, RevLink batches according to policy.
 Scan and distribute correspondence in Onbase workflow as well as complete in box items by the end of each week.
 Maintain equipment appropriately.
 Process electronic remittance run numbers to assist in preparation for posting.
• Refunds:
 Accurately review and resolve credit balances according to policy.
 Inquiries via correspondence, electronic mail, or telephone are to be worked within three business days.
 Comply with the productivity standard established by the department.
• HB Billing Support:
 Accurately review and resolve charge review workqueues daily for wrong log in departments.
 Accurately review and resolve charges out of date range daily.
 Special projects as assigned.
• HB/PB Insurance Follow-Up:
 Accurately review and resolve outstanding invoices in workqueues according to policy along with complying with the productivity standard established by the department.
 Inquiries via correspondence, electronic mail, or telephone are to be worked within three business days.
 Documents all actions taken in a clear, concise, and understandable form.
• PB Charge Entry/Claim Edit:
 Accurately record demographic information for proper billing as well as charge entry for designated providers.
 Comply with the productivity standard established by the department for manual charge entry.
 Accurately review and resolve charge review and claim edit workqueues that are assigned.
 Gather information to prepare charges for entry.
• HB/PB Billing/Claims:
 Accurately review and resolve billing claim edit or follow-up workqueues that are assigned.
 Accurately review daily claim files and print or accept batch runs.
 Accurately review and resolve payer mapping issues in clearinghouse.
 Accurately record demographic information for proper billing as well as charge entry for designated providers.
 Accurately review and resolve when to add appropriate modifiers.
• HB/PB Payment Posting:
 Responsible for accurately posting of checks, EFTs, cash, credit cards, processing electronic files, and no-pay remittances and handling transfers to the appropriate entity accordingly.
 Comply with the productivity standard established by the department for payment posting.
 Accurate preparation of operator summary reports for reconciliation.
• Comp Center Billing:
 Accurately review, resolve issues, and post charges to the appropriate accounts.
 Accurately post checks, EFTs, cash, credit cards, electronic files, and no pay remittances and handling transfers to the appropriate entity accordingly.
 Accurately bill claims and/or statements to ensure compliance and payment on invoices.
 Daily processing/scanning of the incoming postal and inner office mail completed by the end of the normal work day. Carry over is permitted based on large volume of incoming mail.
 Accurately review and resolve outstanding invoices via reports according to policy along with complying with inquiries via correspondence, electronic mail, or telephone are to be worked within three business days.
 Accurately review and resolve credit balances.
 Provide back up to month end processing and reporting.
• Contract Variance:
 Knowledge of Revenue Code, ICD-10 CM, CPT® and HCPCS procedure coding as well as UB04 and CMS 1500 billing requirements.
 This position is responsible for working underpayment variances and logging appeals in Payment Integrity Compass (PIC) for payment recovery tracking and/or Epic.
 This position is responsible for working with the Revenue Cycle Analyst and Supervisor to identify any contract errors in EPIC or PIC for correction.
 This position is responsible for working with the Revenue Cycle Analyst and Supervisor to escalate payor issues that need to be brought to the attention of a payor provider representative.
 This position is responsible for creating and updating contract reference material to be used by other staff to work accounts.
• Bad Debt/Charity:
 Prepare collectability report and upload file for the accounts to be recorded timely to ensure that accounts are classified appropriately without re-work.
 Accurately review and resolve or set tickler for follow-up on outstanding balances in work queues within 7 days of account entering work queue.
 Inquiries via correspondence, electronic mail, or telephone are to be worked within seven to ten business days
 Accurately create and review Onbase workflows for Bad Debt and Charity Transmittals according to policy.
 Coordinates activities and professional relationships with outside vendors such as collection agencies, attorneys, outsourcing vendors, and debt management agencies to facilitate the self- pay collection process established by Deaconess Health System, including supplying necessary documents for court appearances and/or by attending court appearances along with the appropriate vendor.
• Competencies: If applicable and not listed below, please refer to the department for required competencies.
• Employees will be tested on their competency for each area of responsibility that they work upon hire or transition of duties. No additional competencies will be completed unless new duties are assigned or the workflow changes dramatically.
JOB REQUIREMENTS & QUALIFICATIONS
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must clearly demonstrate all required competencies. The education/experience, certifications, skills, physical demands, and work environment described below further define requirements associated with this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Education and Experience
o High School Graduate or GED required.
o Knowledge of health care billing and collection preferred.
o Understanding of debits and credits a plus.
• Certificates, Licenses, Registrations
o None
• Language Skills
o Ability to read, analyze, interpret, and write reports.
• Mathematical Skills
o Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and percentages for discounts.
• Reasoning Ability
o Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Computer Skills
o Technical knowledge of software desirable.
o Basic knowledge of communications hardware and software.
o Must be able to utilize the internet, Word, Excel, Access, and Outlook.
• Other skills, ability or knowledge
o Skill in exercising initiative, judgment, problem solving, and decision making.
o Skill in developing and maintaining effective relationships with employees, managers, physicians, patients, and the general public.
o Must be able to respect the need for confidentiality when dealing with sensitive information.
PHYSICAL DEMANDS
• 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.
o 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. While performing the duties of this job, the employee is regularly required to sit the majority of the time but may be required to climb or balance, stoop, kneel, crouch, or crawl; use wrist and hands to finger, handle, or feel; reach with hands and arms; and talk or hear. Walking may include up to 200 yards at a time. The employee may regularly lift and/or move items up to 20 pounds and occasionally lift up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work Environment
o 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.
o Typically works in settings that are clean, well-lit and temperature controlled. The noise level in the work environment is usually moderate.
o Will occasionally travel to and work in areas of high traffic (people and equipment).
o Works in medium to high stress environment with daily deadlines and frequent interruptions.
FREQUENT DRIVING
• This job does not require frequent driving and an annual motor vehicle record check is not required.
TELECOMMUTING
• This job allows some telecommuting. Telecommuting consists of working from a remote location, typically from home.
OTHER REQUIREMENTS
• Mental and Emotional
o There are mental and emotional requirements of all positions working in a health care setting due to the nature of the services provided. The requirements include: handling multiple priorities, making decisions under pressure, working in close proximity to others and/or in a distracted environment, managing anger/fear/hostility, managing stress appropriately, working with others effectively, and working alone effectively.
• Compliance and Regulatory
o All employees are required to comply with all laws, regulatory guidelines, and health care policies. This includes, but is not limited to: federal, state and local laws, applicable State Departments of Health, Healthcare Facilities Accreditation Program (HFAP), The Joint Commission, Health Insurance Portability and Accountability Act (HIPAA), and Deaconess Policies and Procedures. All employees are required to be compliant with hand hygiene guidelines as well as adhere to safe practices, identifies and reports unsafe practices.