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Patient Accounts Representative

Job ID 150002 Date posted 09/07/2018

Job Summary:
Contributes to the Hospital?s mission by processing hospital claims for services rendered, making diligent efforts to collect the monies owed the hospital, and working with our patients to complete the entire billing process in a manner that meets the hospital goals and maintains a high patient satisfaction. This revenue support staff position will have an impact on financial growth, customer satisfaction, both patient and physician, by completing the billings both accurately and timely as this improves the cash flow for the hospital and improves patient satisfaction.

Consistent with the PROMISE principles and inherent in a hospital environment, employees must be flexible in meeting patients? and the Hospital?s needs. While the list below describes the primary functions of this job, all employees at Winchester Hospital need to recognize that an essential element of their job is the ability to respond to unanticipated and/or changing situations. This may result in assuming responsibilities or tasks which are not on this list.

As part of the billing team, the Patient Accounts Representative:
- Transmits claims electronically and/or via paper to our third party payers on a daily basis.
Monitors accounts for payments, investigating delays and variances.
- Investigates and analyzes failed bills for cause and possible resolution options.

Addresses in a timely manner by, (to include but not limited to):
- Contacting patients for demographics and/or insurance information.
- Contacting physician offices and to update diagnosis ICD and CPT codes to accurately reflect services and medical rationale.
- Reviewing payments for the insurance payor?s appropriate contractual allowance code.
- Entering data into the billing system to adjust for contractually established rates.
- Resubmitting to insurance payer with missed information and/or explanations.
- Issuing refunds, transfers and corrections within department procedures.
- Contacts patients to collect bills that are denied through insurance payers and/or are self-pay.
- Contacts insurance payers to resolve issues and expedite reimbursement.
- Counsels patients on payment options and others on Mass Health Plan options and eligibility and assists them in completing the required application.
- Handles patient/customers complaints timely, efficiently and in a satisfactory manner.
- Escalates concerns to supervisor.
- Using WEB site and other means, audits insurance payer?s acknowledgement reports against submitted bills to quickly identify and address payment versus bill discrepancies.
- Answers and/or addresses mail correspondence and telephone inquiries within expected time frames.
- Escalates billing discrepancies and patient issues that could not be resolved by the Patient Account Representative.
- Identifies and communicates concerning trends related to payers and the reimbursement process.
- After exhausting normal collection processes, recommends to supervisor accounts eligible for Bad Debt or escalation to a collection agency.
- Informs collection agency of cleared claims.
- Documents actions and status of accounts and provides supervisor with feedback.

Department Specific Job Functions:

Patient Financial Services:
- Utilizes the Coding department resources and knowledge to update diagnosis ICD and CPT codes to accurately reflect services and medical rationale.
- Submits credit card documentation to Cash Applications team for processing daily.
- Counsels patients and others on Mass Health Plan options and eligibility and assists them in completing the required application.

Physician Billing Services:
- Posts credit card documentation and submits and documents payments for bank deposit.
- Maintains cash/deposit logs and submits for reconciliation.
- May provide billing back up for physician practices.
- Reviews electronic medical records (EMR) and retrieves pertinent information as requested to resolve claim issues.
- May escalate customer complaints to the hospital Risk Management department depending on the complaint.
- May courier to the post office and/or bank.
- May sort and distribute physician/client and billing service mail.



- High School diploma or equivalent
- At least one year experience in healthcare billing or in a role working with health care insurance.
- Graduation from an accredited medical billing certificate program may be considered in lieu of experience.

- In a hospital, clinic, doctor?s office, or insurance company
- Experience with third party billing

Other Skills/Knowledge:
- For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors and fellow members of the hospital team.
- Strong customer service/relations skills
- Ability to collect money in a professional and empathetic manner.

- Knowledge of third party billing

Physician Billing Services:
- Basic Excel spreadsheet and Word knowledge required.

Patient Financial Services:
- Basic Excel spreadsheet and Word knowledge preferred.



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

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