Antelope Valley Hospital
Patient Account Representative- Business Office - Full Time/Days - Req#209743391
Antelope Valley Hospital, Lancaster, California, us, 93586
Job Objective
Under the supervision of the Collection Supervisor, Director, or designee, performs patient account follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.
Duties and Responsibilities A. Insurance Follow-up, as assigned
Contact insurance carriers regarding outstanding balances until resolution
Resubmit bills to insurance carriers as needed
File insurance carrier appeals for payment and/or denial disputes
Validate accounts for accurate payments, discounts, and contractual adjustments
Reply to insurance carrier correspondence as appropriate
Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
B. Patient Follow-up, as assigned
Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
Contact patients regarding outstanding balances until accounts receivable resolution
Resubmit bills to insurance carriers as needed
Validate bills for accurate discounts and contractual adjustments
Set up payment plans and monitor until resolution
Refer uninsured accounts to Pre-Collection
Assign patient accounts to Bad Debt when appropriate
Communicate with TPL agencies and attorneys
Processes bankruptcy notifications
Review charity care applications and refers to the Director, or Collection Supervisor, for approval or denial
C. Credit Balance, Physician Payment, Trauma Billing, Client Billing, and Miscellaneous Reports Processing, as assigned
Process refund requests for patients and insurance carriers
Process uninsured claims for specialty physicians
Track and trend Medicare Bad Debt assignments for the Cost Report
Research unidentified checks for posting corrections
Non-Essential Duties
Cancel Medicare and Medi-Cal eligible accounts from collection agencies, as assigned
Assist with other duties as assigned, within skill sets and abilities
Knowledge, Skills and Abilities Knowledge
Working knowledge of HMO, PPO, Commercial, Medicare HMO, Medi-Cal HMO, Government, and Workers' Compensation reimbursement
Working knowledge of Managed Care contract language and interpretation
Working knowledge of Microsoft Office applications
Knowledge of basic arithmetic
Skills
Proficient in basic personal computer
Proficient in the use of a calculator
Proficient in the operation of scanners, copiers, and fax machines
Abilities
Ability to handle stress
Ability to manage a heavy caseload in an organized and efficient manner
Ability to recommend appropriate account adjustment and write-off suggestions
Ability to recognize potential accounts receivable related problems and offer solutions to management
Ability to maintain a working relationship with other departments within the organization
Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges
Ability to document account information at time of account follow-up
Ability to run accounts receivable reports as needed
AVH Values
Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.
Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.
Education and Experience Education
High School graduate or equivalent
Experience
Minimum 1-year previous Commercial, HMO, PPO, Medicare HMO, Medi-Cal HMO, Government, and Workers Compensation billing and Insurance follow-up experience
Will consider 2-years’ recent acute care hospital Business Office experience
Required Licensure and/or Certifications
None
AVH Conduct/Compliance Expectations
Ability to adhere with AVH Absenteeism and Tardiness Policy
Ability to adhere with AVH Leaves of Absence Policy
Ability to adhere with AVH Paid Time Off (PTO) Policy
Ability to adhere with AVH Recording of Hours Worked Policy
Ability to adhere to the department dress code
Ability to organize work and establish priorities
Ability to expand on the own initiative in performance of duties
Skill and ability to follow the telephone etiquette/standards
Conforms to AVH Standards of Excellence
Ability to function effectively under pressure and meet time parameters
Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff
Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH
Ability to maintain the confidentiality of patient, hospital and department information
Ability to adhere to safety rules and regulations
Safely and effectively uses all equipment necessary to carry out duties
Ability to interpret and function under hospital and department policies and procedures
Conforms with required and appropriate Joint Commission requirements
Conforms with and supports hospital quality assurance and improvement guidelines
Ability to participate effectively in department and hospital staff education
Display a willingness to work as a team player
Ability to give and support the highest level of patient/customer satisfaction at all times
Supports and adheres to the values and mission statement established by the AVH Board of Directors
Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.
Ability to follow the Code of Conduct
Physical Requirements and Working Conditions
Primarily works in a climate-controlled area
Sitting 80% of time on duty
Tolerate repetitive arm and hand movements
A detailed description of the physical requirements of this job is maintained in the Employee Health Department.
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Duties and Responsibilities A. Insurance Follow-up, as assigned
Contact insurance carriers regarding outstanding balances until resolution
Resubmit bills to insurance carriers as needed
File insurance carrier appeals for payment and/or denial disputes
Validate accounts for accurate payments, discounts, and contractual adjustments
Reply to insurance carrier correspondence as appropriate
Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
B. Patient Follow-up, as assigned
Answer in-coming calls, resolving patient, insurance, and/or vendor issues timely
Contact patients regarding outstanding balances until accounts receivable resolution
Resubmit bills to insurance carriers as needed
Validate bills for accurate discounts and contractual adjustments
Set up payment plans and monitor until resolution
Refer uninsured accounts to Pre-Collection
Assign patient accounts to Bad Debt when appropriate
Communicate with TPL agencies and attorneys
Processes bankruptcy notifications
Review charity care applications and refers to the Director, or Collection Supervisor, for approval or denial
C. Credit Balance, Physician Payment, Trauma Billing, Client Billing, and Miscellaneous Reports Processing, as assigned
Process refund requests for patients and insurance carriers
Process uninsured claims for specialty physicians
Track and trend Medicare Bad Debt assignments for the Cost Report
Research unidentified checks for posting corrections
Non-Essential Duties
Cancel Medicare and Medi-Cal eligible accounts from collection agencies, as assigned
Assist with other duties as assigned, within skill sets and abilities
Knowledge, Skills and Abilities Knowledge
Working knowledge of HMO, PPO, Commercial, Medicare HMO, Medi-Cal HMO, Government, and Workers' Compensation reimbursement
Working knowledge of Managed Care contract language and interpretation
Working knowledge of Microsoft Office applications
Knowledge of basic arithmetic
Skills
Proficient in basic personal computer
Proficient in the use of a calculator
Proficient in the operation of scanners, copiers, and fax machines
Abilities
Ability to handle stress
Ability to manage a heavy caseload in an organized and efficient manner
Ability to recommend appropriate account adjustment and write-off suggestions
Ability to recognize potential accounts receivable related problems and offer solutions to management
Ability to maintain a working relationship with other departments within the organization
Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges
Ability to document account information at time of account follow-up
Ability to run accounts receivable reports as needed
AVH Values
Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.
Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.
Education and Experience Education
High School graduate or equivalent
Experience
Minimum 1-year previous Commercial, HMO, PPO, Medicare HMO, Medi-Cal HMO, Government, and Workers Compensation billing and Insurance follow-up experience
Will consider 2-years’ recent acute care hospital Business Office experience
Required Licensure and/or Certifications
None
AVH Conduct/Compliance Expectations
Ability to adhere with AVH Absenteeism and Tardiness Policy
Ability to adhere with AVH Leaves of Absence Policy
Ability to adhere with AVH Paid Time Off (PTO) Policy
Ability to adhere with AVH Recording of Hours Worked Policy
Ability to adhere to the department dress code
Ability to organize work and establish priorities
Ability to expand on the own initiative in performance of duties
Skill and ability to follow the telephone etiquette/standards
Conforms to AVH Standards of Excellence
Ability to function effectively under pressure and meet time parameters
Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff
Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH
Ability to maintain the confidentiality of patient, hospital and department information
Ability to adhere to safety rules and regulations
Safely and effectively uses all equipment necessary to carry out duties
Ability to interpret and function under hospital and department policies and procedures
Conforms with required and appropriate Joint Commission requirements
Conforms with and supports hospital quality assurance and improvement guidelines
Ability to participate effectively in department and hospital staff education
Display a willingness to work as a team player
Ability to give and support the highest level of patient/customer satisfaction at all times
Supports and adheres to the values and mission statement established by the AVH Board of Directors
Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.
Ability to follow the Code of Conduct
Physical Requirements and Working Conditions
Primarily works in a climate-controlled area
Sitting 80% of time on duty
Tolerate repetitive arm and hand movements
A detailed description of the physical requirements of this job is maintained in the Employee Health Department.
#J-18808-Ljbffr