Patient Account Representative II - Stanford Health Care (California)
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Job Summary
The Patient Account Representative II (PAR II) is responsible for the timely and accurate processing of patient accounts receivable billing and collections. The specific job duties will be comprised of a combination of responsibilities from among the various areas of PFS operations including Charge entry and charge batch balancing, Electronic and hardcopy claims editing and submission to various payers (Government, Managed Care, and Commercial), Accounts receivable collections and payer follow-up, Payer denial review and appeals processing, Customer service, Payment applications, Credit balance review and resolution and Patient advocacy and risk management. Under general supervision, PAR II performs the full range of duties for this assigned class. Requires a good working knowledge of systems and processes and be expected to resolve standard queries and problems. Works on assignments that are moderately complex in nature where judgment is required in resolving problems and making routine recommendations.
Job Duties
The job duties listed are typical examples of work performed by positions in this job classification, and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility. Employees may also perform other duties as assigned.
Account Reps: Follows up on unpaid accounts in patient accounting systems with the payers either by phone or via websites. Works payer denials based on claim process adjudication; Review accounts for possible underpayments; research contracts, guidelines and resolve payment with payer. Perform appeals with payer. Performs bad debt request transfers as applicable. Performs or requests adjustment and contractual write offs as applicable
Billers: Reviews EPIC worklists and edits accounts as needed; Reviews Cirius claim edits and resolves edits; Reviews and resolves electronic acknowledgement payer rejections/denials; Rebills claims based on requests from Follow Up reps due to denials received. Resends claim as needed.
Cash Posting Reps: Posts payments; Work EPIC undistributed payment worklist; Posts adjustments related to payments. Processes refunds for accounts payable. Posts payment transfers from professional billing to hospital billing. Responsible for processing electronic and manual remittance transactions. Posting complex payment and contractual adjustments to patient accounts. Responsible for reconciling cash transactions, third party remittances, and credit/debit card payments. Representative downloads posts and reconciles electronic remittance files and works with the billing and collections representatives to resolve posting problems.
Data Control Reps: Enters charges; Reviews EPIC worklist accounts with charge issues and resolves; Researches charge issues and follows up with departments as needed. Complete charge corrections including adding diagnosis, transferring or reversing charges, combining accounts.
Maintains professional communication with various PFS staff, medical center staff, payors, physicians, and patients regarding the billing of services rendered at Stanford Medical Center. Communication may consist of telephone, correspondence, or in person contact.
Meets weekly individual productivity goals and standards while following planned priorities as set by the Team Manager/Coordinator.
Minimum Qualifications
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
**Education:** High School diploma or GED equivalent
**Experience:** Two (2) years of progressively responsible and directly related work experience
Knowledge, Skills, and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to follow oral and written instructions and interpret institutional and other policies accurately.
Ability to gather, analyze, and display data in appropriate format and keep accurate records.
Ability to maintain confidentiality of sensitive information.
Ability to perform basic mathematics.
Ability to plan, prioritize and meet deadlines.
Ability to work effectively with individuals at all levels of the organization.
Knowledge of accounts receivable system like SMS, IDX, or Meditech.
Knowledge of computer systems and software used in functional area.
Knowledge of medical reimbursement policies and procedures.
Knowledge of medical terminology and insurance claim procedures common to medical billing and accounts receivable operations.
Knowledge of one or more of the following: Medicare, Medi-Cal, Worker's Comp or Managed Care (HMO,PPO,POS, etc).
Knowledge of principles and practices of customer service and telephone courtesy.
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Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in** **all of** **its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
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