BWPO PATIENT ACCOUNT REP.

Affiliate Name: Brigham & Women's Physicians Organization
Job Category: Financial/Accounting/Billing
Department: BWPO RADIOLOGY
Hours/Week: 40
Job Type: Regular
Employment Type: Full TimeResponsibilities:
GENERAL SUMMARY/OVERVIEW:Working under the general supervision of a billing manager, billing supervisor, or team leader, perform a wide variety of charge posting, payment posting, accounts receivable follow-up, or other duties in one of the ancillary department billing groups of the BWPO. The ancillary billing groups process a high volume of charge transactions with a very large number of patient accounts. The patient account representative is required to handle a diverse mix of job responsibilities and exercise a high degree of initiative in handling issues and problems that arise across the spectrum of billing functions.PRINCIPAL DUTIES AND RESPONSIBILITIES:1.Responsible for posting of electronic charge interface files received in IDX and in resolving all problems raised on billing edit reports from interface files so that all charges are posted accurately and in a timely manner. This involves a thorough understanding of edit reports in IDX, as well as knowledge of the respective source charge code, patient encounter, and demographic information to be able to make corrections. Using own initiative and under general supervision, researches problems and determines correct information. This may involve accessing clinical computer system where source information resides, contacting departmental/practice representatives to provide additional information, researching source clinical report documents to verify information, etc..
2.Responsible for posting of manual billing charges based on paper source documentation. This involves thorough knowledge of charge code or clinical information, as well as demographic information, to be able to post charges accurately. Troubleshoot and resolve all charge posting questions as necessary. This may involve accessing clinical computer system where source information resides, contacting departmental/practice representatives to provide additional information, researching source clinical report documents to verify information, etc..
3.Handle all telephone inquiries and written inquires from patients regarding their accounts. Requires ability to research and resolve a wide variety of patient billing or insurance coverage issues under only general supervision.
4.Receive and respond to calls from third party payers and other health care providers regarding patient accounts. Follow-up on unresolved issues relating to patient accounts by telephone or written correspondence with third party payers, patients, referring physicians, or with representatives of clinical departments.
5.Sort, review and revise outgoing third party insurance claim forms and statements, attaching all required reports as necessary. Requires knowledge of claim form logic specific to a variety of individual insurance companies.
6.Post payments to IDX accounts based on remittance information provided by third party payers. Needs to accurately record all information and to be able to identify incorrect or partial payments on account and to be able to follow-up as necessary to resolve discrepancies. Requires familiarity with group charge code structure, third party fee schedules, as well as familiarity with individual patient insurance coverage to be able to interpret payment based on individual patient primary and secondary insurance coverage.
7.Research and follow-up on payment denials from third party payers on patient accounts. This requires the ability to interpret various third party payor payment policies to determine whether or not denial is valid. Working under only general supervision, searches source documentation or contacts clinical department representatives or other individuals to gather necessary information and/or reports to appeal individual claim denial. Prepare appeal to third party payor as necessary.
8.Assist with the research and resolution of outstanding patient accounts receivable. This may involve directly contacting a third party payor, or patient, to investigate the reason for delinquency of account and the provision of additional or missing information to expedite payment. Under general supervision and following Group policies, make specific arrangements as necessary for payment of patient account (e.g. setting up payment plans).
9.Assist with reconciliation of bank statements, lock-box payments, and patient accounts as required.
10.Assists in training new or more junior staff in any or all of the above job duties as required.
11.Assist with other general duties such as photocopying reports, producing and distributing reports, sorting mail, delivery materials to other office locations, etc.
12.Maintains established BWPO policies, procedures and objectives, including the areas of corporate compliance, safety, and other personnel policies.
13.Performs all other duties and responsibilities as directed.
REQUIREMENTS
QUALIFICATIONS:High School degree or equivalent.
1-2 years of third party billing experience, preferably with an IDX system. Other relevant experience such as in customer service, claims processing , account management, in a financial institution, insurance company, etc., may be used in lieu of some direct third party billing experience.SKILLS/ABILITIES/COMPETENCIES REQUIRED:1.Very detailed oriented, with the ability to process a high volume of information under tight timeframes. The consequences of inaccuracy can be damaging not only from a patient satisfaction standpoint, but also from a financial as well as a regulatory/compliance standpoint.
2.Strong computer skills to be able to handle a number of different routines and to understand sometimes complex patient accounts.
3.Strong interpersonal skills to handle effectively sometimes sensitive patient account situations.
4.Good communications skills to be able to interact with patients, physicians, insurance representatives, administrative contacts, etc..
5.Ability to function independently with only general supervision. Displays initiative and uses good judgment.
6.Ability to handle very confidential patient information with discretion and tact, observing all Hospital and PO policies.
7.Need to be able to troubleshoot problems, develop workable solutions to problems, and to follow-up on problem resolution. Must be able to prioritize work and to handle multiple, sometimes conflicting, tasks using sound judgment.