Certified Patient Account Representative Chambersburg Days

Full time (40 hours weekly)
M-F Flex option of 6a-2:30p 6:30a-3p 7a-3:30p 7:30a-4p 8a-4:30p or 8:30a-5p

Position Function: Under the direction of the Assistant Patient Account Manager is responsible for the billing of Medicare Medical Assistance Blue Cross Highmark Blue Shield Tricare commercial insurance managed care auto workers compensation and other payors to the appropriate intermediary or third party payor. Receives and reviews direct pay accounts past due bills and follow-up documents for all direct pay accounts of a specified collection group. Contacts payors and patients to secure payments or arrange alternative settlement plans.

Essential Functions and Responsibilities
Unit Based Essential Functions and Responsibilities

Core Values: Service Integrity Compassion
service excellence and patient and family centered care by showing respect honesty fairness and a positive attitude toward all customers.
confidentiality.
dependability to include attendance and punctuality.
accountable - takes initiative and ownership of issues.
a professional demeanor. Represents hospital in a positive way. Has a compassionate working relationship with patients and families.
personal responsibility for 2-way communication. Communicates and listens effectively with patients families coworkers other departments physicians/providers and community.
coworkers initiatives and a patient and family centered philosophy; pitches in; does own part and helps others.
to continuously improve work environment/processes (Performance Improvement). Demonstrates a patient and family centered focus when considering/developing improvement solutions.
willingness/enthusiasm to create embrace and facilitate change.
self and others; supports a learning environment; leads by example. Encourages patients and families to give feedback and suggestions for improvement.
working relationships critical to the organization including patients families coworkers other departments physicians/providers and community.
others by providing recognition and support.

Technical Excellence
critically; utilizes sound judgment; promptly reports potential risks.
state of art knowledge of area of specialty healthcare trends and practice and populations served.
a level of computer literacy appropriate to their role.
and maintains current all unit specific and organizational skills/competencies certifications/licensures as required.
hospital-required reviews e.g. HIPAA safety health screening care concerns and others as assigned.
to National Patient Safety Goals.

Job Specifics
Payor Regulations as they apply to billing cash payments and patient responsibilities. Adheres to regulations. Reports any activity suspected as non-compliant to the Compliance Hot Line. Also reports to Hot Line any situation where a person of influence has directed the employee to adopt a process suspected to be non-compliant.
and maintains accuracy integrity and completeness in all records reports and claims issued in conjunction with responsibilities.
workload at the beginning of shift so that important deadlines are met. Informs Assistant Patient Account Manager of any problems which would prevent the timely completion of work.
all communication to patients their agents and Hospital agents with the highest regard for good customer service. Treats all external customers with a high degree of respect.
scheduled departmental in-services and staff meetings to develop communication skills learn new forms/procedures etc.
in special projects conducted by the department or other area as workload permits.
in disaster and other emergency drills M-1 disaster or evacuation.
and follows hospital fire and safety procedures for satellite facilities knows personal role in case of fire.
a neat clean work area. Communicates housekeeping needs as appropriate.
participates in the management of information either through a computerized fashion manual or paper-based system.
for each Sorts Biller Queue daily. Identifies proper financial classification accounts. Keys insurance changes to be made prior to final billing.
for each Changes Collection Group insurance information and updates statement information as appropriate when pertinent information is received or on a daily basis.
insurance coverage if applicable. Notifies Registration Utilization Review and HIM of corrections and additions.
reports to Assistant Patient Account Manager any special situations or problems affecting receipt of payment.
mail daily; responds as appropriate within five working days.
in cross-training efforts to facilitate staff coverage during absences and to promote teamwork.
items to be scanned and appropriately scans to either the patient account or scans documentation in batches.
scanned documents for accuracy for future retrieval.

CPS Group
adjustments for small balances Charity write offs and other charges not payable by insurance or the patient as per established guidelines.
completes bank deposits and ensures accuracy between deposits and what was posted to individual patient accounts in Meditech.
Bad Debt Recovery Report notifies collectors of payments write-offs and differences in balances daily. Responds to all correspondence from collectors daily.
all inquiries pertinent to insurance information from patients collectors etc.; researches as appropriate paying close attention to detail.
delinquent accounts and related documents; identifies additional information needs; contacts proper billing staff or other appropriate personnel to obtain pertinent information/clarification as needed.
alternate payment plans based on department guidelines. Follows guidelines as outlined in policy and procedure.
the phone in accordance with department policy. Takes complete phone messages to include caller data and response requested. Displays proper telephone etiquette and respect for external customers at all times.
self-pay surgical accounts prior to service to arrange payment.
charges as requested by patients wanting to comparison shop for services.
department guidelines for maintaining all miscellaneous CPS WQ as required.
department guidelines for ensuring accurate financial and biographical information.
department guidelines for action items including follow up rebilling or adjustments.

HB Billing Group
hospital bill. Mails or electronically submits itemized bills to include any necessary coding needed to comply with third party payor requirements. Completes billing by five working days following final billing.
department guidelines for maintaining all miscellaneous biller WQs as required.
department guidelines for maintaining A/R Follow Up WQs as required. Resolves accounts due to no payment on account balances in a timely manner. Appropriately notes accounts with claim status from insurance websites or insurance customer service.
department guidelines for maintaining Claim Edits and Rejections WQs as required. Makes telephone calls to insurance carriers if needed in order for resolve rejections in a timely manner.
department guidelines of Denials WQ as required. Track trend and investigate denials with insurance companies. Send appeals when required. Make sure account is ready to drop to secondary insurance. Bills any late charges when necessary.
appropriate adjustments if claims have processed correctly.
corrects insurance when receiving denials for incorrect coverage. Rebill account.
or update patient data into computer.
to Assistant Patient Account Manager any known Payor trends that may prohibit timely billing of claims or payments.
cash receipts or payment transmittals for patient or insurance company refunds. References cash receipts or payment transmittals as source documentation for action taken as per established guidelines and instructions.
and completes refunds as per standard procedure

Payment Posting Group
insurance payments to proper account and bill number.
clearing account for electronically posted remittances daily/weekly.

PFR Group
assigned completes WellSpan Financial Assistance Application and Medical Assistance applications according to current guidelines.
WellSpan Financial Assistance Application bankruptcy weekly as per established guidelines; prepares and maintains files in area of responsibility.

General Requirements

The following requirements are expected of all employees:

Core Values: Integrity Compassion Excellence Service
Annual Health Screening with Infection Control and Blood Borne Pathogens Education
Safety Awareness: Hospital Fire Safety and Disaster Procedures
Confidentiality: Maintains Employee and Patient Confidentiality.
Attendance: Regular attendance is an essential function of the position
Leadership Standards:
Character: Attitude Integrity Role Modeling
Job Performance: Results Orientation Customer Focus Decision Making Awareness
Interpersonal Skills: Communication Relationship-building Team Player Celebration
Innovation: Breakthrough Thinking Knowledge-Building/Sharing Coaching/Empowering System Vision & Management

Physical and Mental Requirements: Classified as sedentary work by the Dictionary of Occupational Titles: May exert up to 10 pounds of force occasionally and/or an insignificant amount of force frequently or constantly in order to lift carry push pull or otherwise move objects.

Work involves sitting most of the time on a hard or cushioned chair but may also involve walking throughout the hospital facility or standing for brief periods of time.
Walks through hospital facility.
Sits on a hard or cushioned chair frequently.
Lifts up to 20 pounds to and from all levels (floor waist shoulder overhead) on an occasional basis.
Carries up to 15 pounds occasionally through the hospital.
Bends twists squats and kneels occasionally.
Reaches up to 2 feet overhead/in front of oneself on an occasional basis.
Near-visual acuity with color perception in order to view computer screen and decipher fine print.
Manual dexterity adequate for utilizing a keyboard calculator and embossing machine and processing paperwork.
Ability to adapt to simultaneous multiple and varied stimuli.
Auditory acuity for hearing telephone conversation normal voice tones when not facing the individual alarms call bells overhead pages etc.
Clear speaking voice in order to communicate effectively with incoming patients and utilize paging system.
Mental Demands-Ability to communicate effectively in both verbal and written form; ability to speak read and write in English language.
Must be able to work within time constraints and adjust to multiple simultaneous stimuli.

Working Environment: Work is performed in a clean well-ventilated indoor environment; may require sitting for uninterrupted periods of time.

Reporting Structure: Reports to Assistant Patient Account Manager in his/her absence reports to the Manager in their respective HB or CPS both their absences reports to Director Patient Financial Services.

Disclaimer: These essential job functions are requirements of the position which must be performed either with or without reasonable accommodation. The essential job function list is intended to be a guide rather than a limitation. The Chambersburg Hospital possesses the right to add new responsibilities to the list as business demands dictate. Some of the essential job functions may exclude individuals who pose a direct threat/significant risk to the health and safety of themselves or others.

By identifying essential job functions we are in no way stating or implying that these required tasks are the only activities that are to be performed by the employee occupying this addition employees will also be expected to follow any other job-related instructions and to perform any other job-related duties that are included in the job description. The preceding requirements represent only the minimum acceptable levels of knowledge skills and/or abilities that a job incumbent must possess; in order to perform the job successfully the incumbent will possess additional aptitudes so as to perform the other duties that the job description entails.

Qualifications and Standards

Education: High school graduate or G.E.D. required. Courses in bookkeeping computing and accounting preferred. Informal or Continuing Education-As appropriate for updated billing trends or techniques.

Experience: Experience applying customer service behaviors and communication skills required. Six months to one year experience in clerical work related to health insurance preferred. Typing skills at a minimum of 30 words per minute. Excellent organizational skills and experience in customer service required. Trained to operate a calculator.

Certifications/Licensure: Certification by the HealthCare Financial Management Association (HFMA) of Certified Revenue Cycle Representative (CRCR) required.