Denton Surgery Center, LLC
Patient Account Representative - Medical Billing - Treasure Valley Hospital
Denton Surgery Center, LLC, Boise, Idaho, United States, 83708
Overview
At SCA Health, we believe
health care is about people
– the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the
mission, vision and values
that define our organization.
As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.
What sets SCA Health apart isn’t just what we do, it’s how we do it . Each decision we make is rooted in
seven core values :
Clinical quality
Integrity
Service excellence
Teamwork
Accountability
Continuous improvement
Inclusion
Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits.
Your ideas should inspire change. If you join our team,
they will .
Responsibilities JOB KNOWLEDGE
Credit Balance & Insurance Resolution:
Resolve patient and insurance account balances (primary, secondary, self-pay).
Work with insurance companies to ensure payments are processed correctly.
Manage and resolve outstanding claims or accounts in a timely manner.
Achieve cash collection metrics and goals set by the department.
Accounts Receivable Follow-Up:
Ensure accurate and timely follow-up on all accounts receivable.
Maximize facility reimbursement by working with insurance providers to resolve issues.
Denials and Claims:
Handle denials and corrected claims independently and collaborate with billing team to resolve.
Understand payer contracts and utilize them for accurate billing and reimbursement.
Customer Interaction:
Provide professional responses to patient and payer inquiries.
Work with patients and providers to explain insurance coverage, EOBs, and billing issues.
ESSENTIAL POSITION RESPONSIBILITIES
Billing & Accounts Receivable:
Bill and re-bill primary, secondary, and tertiary insurance claims daily.
Maintain knowledge of third-party billing requirements and current insurance coverage allowances.
Ensure accurate and timely follow-up of unpaid balances, including processing claims, re-bills, and remittances.
Work with insurance representatives to resolve denied claims and adjust accounts as needed.
Meet productivity goals and follow departmental guidelines for billing and claims management.
Communication & Customer Service:
Communicate effectively with insurance representatives, patients, and other staff to resolve issues and ensure proper reimbursement.
Notify the Billing Office Manager of any issues or claims that cannot be billed on the date received.
Maintain confidentiality and professionalism in all patient and departmental communications. Problem-Solving & Decision-Making:
Utilize judgment to resolve complex billing issues and provide patient assistance in reconciling account balances.
Handle patient and insurance inquiries independently, using experience and knowledge to ensure accurate account resolution.
Productivity & Time Management:
Maintain a high level of productivity, ensuring timely billing and follow-up on a minimum of 70% of accounts needing attention.
Prioritize tasks, demonstrate initiative, and meet deadlines while maintaining accuracy.
Support team efforts to achieve departmental goals and contribute to a positive work environment.
Compliance & Attitude:
Adhere to all hospital policies, procedures, and industry best practices.
Display a positive, flexible attitude toward change and work collaboratively with colleagues.
Demonstrate respect for co-workers, patients, and hospital procedures, ensuring a professional and respectful environment.
Position Purpose
Work closely with insurance companies and third-party payers to collect revenue for surgical services performed.
Collect payments from insurance companies as opposed from collecting from self-pay individuals.
Works closely with payer provider relations representatives.
Contacting insurance companies by email, website, and phone to collect payments.
Manages contracted and non-contracted, Government, Commercial, Medicare Advantage, Workers Compensation, and self-pay.
Works all denials and corrected claims collaborating with the biller and insurance payers and/or patients on past due accounts.
Has the ability to calculate and verify insurance coverage including pre-authorization, patient co-pay and deductibles.
Coordinate with Physician offices to ensure pre-authorization is obtained with the appropriate scope for CPT and ICD 10 codes.
Posts and reconciles payments daily including EFT (835 files) from insurance and cash and check from insurance and patients.
Primary functions are credit balance management, patient balance and insurance resolution
Ensure payments by primary and secondary payers and self-pay patients are accurate
Responsible for thorough and timely patient account follow up to ensure accurate accounts receivable reporting
Accurate and timely follow-up and resolution for all accounts receivable.
Meeting and maintaining cash collection metrics and goals
Effectively and independently manages second level reimbursement issues, contracted and non-contracted denials and appeals.
This is a demanding environment, which requires attention to detail, accountability, and teamwork.
Qualifications
Proven experience
auditing and reviewing medical claims
Strong working knowledge of
Workers’ Compensation billing requirements
Experience with
Commercial insurance plans
and payer‑specific billing rules
Ability to identify underpayments, denials, and billing inaccuracies
Solid understanding of CPT, ICD‑10, and modifier usage
Experience collaborating with payers, internal billing teams, and clinical partners to resolve complex claims
CPC certification is preferred but not required.
Associate’s degree or equivalent from a two-year College or technical school; and two years’ experience in a medical office as a patient account representative.
High school graduate. Previous clinical, accounts receivable, medical billing appeals and patient billing and collection experience required.
Demonstrates a working knowledge of ICD, CPT, HCPC and revenue codes and the ability to assess and resolve claim denials.
1-2 years’ experience preferred in medical insurance, collections, billing accounts receivable, and patient collections, ideally within a hospital environment.
Effective communication skills, both verbally and in writing.
Understand medical insurance contracts, coverages, and limitations.
Use analytical problem-solving techniques to reconcile patient balances.
Makes decisions based on experience and knowledge.
Demonstrates accountability in actions and words.
Follows industry best practices as outlined.
Contributes to the growth and health of the department.
USD $18.00/Hr. USD $23.00/Hr.
#J-18808-Ljbffr
health care is about people
– the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the
mission, vision and values
that define our organization.
As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.
What sets SCA Health apart isn’t just what we do, it’s how we do it . Each decision we make is rooted in
seven core values :
Clinical quality
Integrity
Service excellence
Teamwork
Accountability
Continuous improvement
Inclusion
Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits.
Your ideas should inspire change. If you join our team,
they will .
Responsibilities JOB KNOWLEDGE
Credit Balance & Insurance Resolution:
Resolve patient and insurance account balances (primary, secondary, self-pay).
Work with insurance companies to ensure payments are processed correctly.
Manage and resolve outstanding claims or accounts in a timely manner.
Achieve cash collection metrics and goals set by the department.
Accounts Receivable Follow-Up:
Ensure accurate and timely follow-up on all accounts receivable.
Maximize facility reimbursement by working with insurance providers to resolve issues.
Denials and Claims:
Handle denials and corrected claims independently and collaborate with billing team to resolve.
Understand payer contracts and utilize them for accurate billing and reimbursement.
Customer Interaction:
Provide professional responses to patient and payer inquiries.
Work with patients and providers to explain insurance coverage, EOBs, and billing issues.
ESSENTIAL POSITION RESPONSIBILITIES
Billing & Accounts Receivable:
Bill and re-bill primary, secondary, and tertiary insurance claims daily.
Maintain knowledge of third-party billing requirements and current insurance coverage allowances.
Ensure accurate and timely follow-up of unpaid balances, including processing claims, re-bills, and remittances.
Work with insurance representatives to resolve denied claims and adjust accounts as needed.
Meet productivity goals and follow departmental guidelines for billing and claims management.
Communication & Customer Service:
Communicate effectively with insurance representatives, patients, and other staff to resolve issues and ensure proper reimbursement.
Notify the Billing Office Manager of any issues or claims that cannot be billed on the date received.
Maintain confidentiality and professionalism in all patient and departmental communications. Problem-Solving & Decision-Making:
Utilize judgment to resolve complex billing issues and provide patient assistance in reconciling account balances.
Handle patient and insurance inquiries independently, using experience and knowledge to ensure accurate account resolution.
Productivity & Time Management:
Maintain a high level of productivity, ensuring timely billing and follow-up on a minimum of 70% of accounts needing attention.
Prioritize tasks, demonstrate initiative, and meet deadlines while maintaining accuracy.
Support team efforts to achieve departmental goals and contribute to a positive work environment.
Compliance & Attitude:
Adhere to all hospital policies, procedures, and industry best practices.
Display a positive, flexible attitude toward change and work collaboratively with colleagues.
Demonstrate respect for co-workers, patients, and hospital procedures, ensuring a professional and respectful environment.
Position Purpose
Work closely with insurance companies and third-party payers to collect revenue for surgical services performed.
Collect payments from insurance companies as opposed from collecting from self-pay individuals.
Works closely with payer provider relations representatives.
Contacting insurance companies by email, website, and phone to collect payments.
Manages contracted and non-contracted, Government, Commercial, Medicare Advantage, Workers Compensation, and self-pay.
Works all denials and corrected claims collaborating with the biller and insurance payers and/or patients on past due accounts.
Has the ability to calculate and verify insurance coverage including pre-authorization, patient co-pay and deductibles.
Coordinate with Physician offices to ensure pre-authorization is obtained with the appropriate scope for CPT and ICD 10 codes.
Posts and reconciles payments daily including EFT (835 files) from insurance and cash and check from insurance and patients.
Primary functions are credit balance management, patient balance and insurance resolution
Ensure payments by primary and secondary payers and self-pay patients are accurate
Responsible for thorough and timely patient account follow up to ensure accurate accounts receivable reporting
Accurate and timely follow-up and resolution for all accounts receivable.
Meeting and maintaining cash collection metrics and goals
Effectively and independently manages second level reimbursement issues, contracted and non-contracted denials and appeals.
This is a demanding environment, which requires attention to detail, accountability, and teamwork.
Qualifications
Proven experience
auditing and reviewing medical claims
Strong working knowledge of
Workers’ Compensation billing requirements
Experience with
Commercial insurance plans
and payer‑specific billing rules
Ability to identify underpayments, denials, and billing inaccuracies
Solid understanding of CPT, ICD‑10, and modifier usage
Experience collaborating with payers, internal billing teams, and clinical partners to resolve complex claims
CPC certification is preferred but not required.
Associate’s degree or equivalent from a two-year College or technical school; and two years’ experience in a medical office as a patient account representative.
High school graduate. Previous clinical, accounts receivable, medical billing appeals and patient billing and collection experience required.
Demonstrates a working knowledge of ICD, CPT, HCPC and revenue codes and the ability to assess and resolve claim denials.
1-2 years’ experience preferred in medical insurance, collections, billing accounts receivable, and patient collections, ideally within a hospital environment.
Effective communication skills, both verbally and in writing.
Understand medical insurance contracts, coverages, and limitations.
Use analytical problem-solving techniques to reconcile patient balances.
Makes decisions based on experience and knowledge.
Demonstrates accountability in actions and words.
Follows industry best practices as outlined.
Contributes to the growth and health of the department.
USD $18.00/Hr. USD $23.00/Hr.
#J-18808-Ljbffr