Job Family :

Patient Account Representative

Travel Required :

None

Clearance Required :

None

What You Will Do :

The Senior Patient Account Representative is expected to perform specific areas of billing, follow up, account resolution, adjustment posting, adjustment refunds and scanning as required. This position works with other departments to facilitate the meeting of both departmental and facility goals and objectives. This position is responsible for verifying that payments received are correct per our contract and for ensuring customer satisfaction and demonstrating the ability to find solutions to problems and keeping management informed of patterns regarding payments and or other issues with specific payers. The Senior Patient Account Representative has an extensive knowledge of billing, managed care, timely filing guidelines, and the ability to effectively review remittance advices and electronic billing reports from payer to determine the action required. This position performs all related job duties as assigned. This position is 100% onsite. Office hours are M-F, 8:00am-4:30pm.

Primary Duties and Responsibilities:

• Training and development of staff including creating, updating, and maintaining training manual.

• New hire training and feedback, assist staff with questions, taking ownership and finding the answer.

• Assist Supervisor as needed.

• Run daily WIP report and communicate any trends same day.

• Complete all assigned spreadsheets and reports timely.

• Contacts third party payers and guarantors electronically and via phone to resolve account balances on all assigned accounts.

• Works all correspondence within 24 hours or receipt. Detail notes regarding correspondence must be entered into the system.

• Works all denials within 48 hours of receipt taking whatever action may be required to obtain account resolution.

• Appeals all accounts denied for medical necessity, authorizations, length of stay and timely filing issues.

• Monitors all denials for trends and issues and reports finding to supervisor.

• Bills or re-bills, as necessary.

• Ensures the hospital is in compliance with all state and federal rules and regulations both billing and HIPAA.

• Assigned special projects will be completed within the time frames given.

• Facilitate and/or conduct training sessions and seminars offered by the Hospital and Third-Party Payers.

• Appropriately documents each account worked in patient accounting system.

• Reviews same day and 72-hour admission report to determine if accounts need to be combined.

• Makes necessary corrections in electronic billing system.

• Adjusts billings based on audits and or changes in diagnosis or DRG.

• Updates patient accounts with corrected demographic or insurance information.

• Posts adjustments.

• Calls insurance companies to obtain correct information when unable to identify if account payment is to be posted.

• Respond to all emails both internal and external in a professional and courteous manner and within 24 hours.

• Follows the mission state and values established by the facility.

• Stays current with HIM trends, relevant rules, regulations, and directives from regulatory agencies and third-party payers.

What You Will Need :

• High School diploma.

• 1-3 years billing or follow-up experience in healthcare field.

What Would Be Nice to Have :

• Metrix system knowledge

• Waystar Billing System knowledge

• CPAR certification preferred.

• Excellent communication and interpersonal skills

• Experience with Microsoft Excel and Word.

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What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.