Patient Representative Coordinator| Baldwin

Major Responsibilities:

• Provides direct supervision to the Patient Account Representative IIs and IIIs in the Patient Business Office. Analyzes fluctuations in accounts receivable volume and makes appropriate recommendations for adjustments in staffing within department budget parameters. Assists the staff and management in researching complex billing issues utilizing the UB editor Medicare and Medicaid coding manuals and the Patient Business Office billing manuals and other resources as appropriate

• Conducts research complex analysis and follow-up on insurance claims performs rebills and reprints as necessary performs bad debt write-offs charity write-offs and enters contractual adjustments as necessary and/or posts payments in a timely manner. Uses knowledge of hospital services and cost of services third-party billing requirements rules of subrogation and coordination of benefits credit and collection laws and computer system functions in performing job duties.

• Oversees the billing collection and/or posting activities of the staff and ensures timely resolution of accounts. Monitors productivity and ensures compliance with policies and procedures. Holds staff accountable for productivity standard.

• Reviews quality audits looking for trends and training collaboration with Quality Control Analyst and Manager provides training to the staff when needed. Reviews audit results with each team member on a regular basis.

• Participates in hiring training corrective action and motivation of staff as needed. Provides orientation for new employees and ensures continuing education requirements are satisfied. Provides input to the Manager for all staff evaluations.

• Participates in weekly discussions with Manager related to departmental improvement opportunities. Notifies appropriate staff of new issues denial trends and other reimbursement challenges.

• Collaborates with Revenue Management Department and Governmental Denial Coordinator to address and resolve Medicare and/or Medicaid claims reimbursement issues.

• Ensures any claims audited by RMD are rebilled in a timely manner. Provides input to the response to any governmental payor audits or reviews.

• Stays abreast of all insurance billing and reimbursement regulations by reading all updates from the applicable payers in a timely manner and reacts as appropriate to avoid any compliance issues. Reads and interprets Medicare provider education articles and GHP web banner messages as they are published. Changes billing practices based on changes in regulations.

• Gains and exhibits appropriate financial knowledge. Understands the significance and impact processes have on Accounts Receivable. Understands the financial calculations used in monitoring the success of the Patient Business Office.

• Regularly monitors work area for potential employee hazards. Reports all safety concerns to the Prevention and Control Officer.

• Assists Manager with other special projects reports and job responsibilities as defined by management as needed.

• Attends developmental opportunities that further enhance work skills personal growth and development.

Licensure Registration and/or Certification Required:

• Must be CPAR or obtain certification within 2 years of obtaining position.

Education Required:

• Requires a high school diploma or GED. Bachelors Degree or higher preferred but not required.

Experience Required:

• Minimum of 4 years of experience in accounting insurance collections or other related field. Education may be substituted at a ratio of one year of education equal to 2 years of experience.

Knowledge Skills & Abilities Required:

• Communicates effectively both verbally and in writing. Exhibits leadership and problem solving skills. Must be proficient in utilizing personal computers.

Physical Requirements and Working Conditions:

• Must be able to use visual acuity to see monitor screen computer and hard copy materials. Must be able to hear and verbally communicate in person and over the phone or radio. Must be able to sit for prolonged periods of time (up to 2 hours). Must be able to comprehend and learn operation of various office equipment. Must have functional range of motion of the cervical thoracic and lumbar spines upper and lower extremities with a grip strength of 50-60# specific to job evaluation. Must be able to forward reach overhead reach bend squat kneel and apply proper body mechanics during the transfers and transport supplies and/or equipment using proper body mechanics. Must be able to lift up to 10# specific to job evaluation.

• Works in hospital clinical and/or assistive living office indoor environments. Must be able to remain calm under emergency situations. Must be able to utilize appropriate universal and specific precautions for protection from potential exposure infectious or communicable diseases. Tolerate high noise busy atmospheres and noxious odors.

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