Patient Account Representative

Title: Patient Account Representative

Location: United States

Job Description:

Our Mission

All of us, for each of you, every time.

Our Vision

Together, serving as the trusted regional healthcare partner.

Our Values

Listen~Love~Respect~Excel~Innovate

At Samaritan, we do more than deliver healthcare-we make a meaningful difference in the lives of our community every day. We're committed to creating an exceptional workplace where professionals feel valued, supported, and inspired to provide outstanding care to every patient we serve. This position is responsible for accurately billing patient accounts, ensuring timely claim submission and reimbursement from various third-party payers, ensuring proper account documentation in the organizations billing system, and pursuing follow-up efforts on aged accounts.

This is a full-time remote position that will be required to come on-site for onboarding and equipment pick-up (2 DAYS ONLY). This is a full-time role working Monday-Friday from 8:00 AM - 4:30 PM PST.

ESSENTIAL FUNCTIONS

• Completes daily electronic billing file and submits insurance claims to third-party payers.
• Reviews, evaluates, and forwards paper claims to payers that do not accept electronic claims or that require special handling.
• Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leadership.
• Answers multi-line phone quickly and courteously, answer patients/guarantors concerns/questions with regards to billing, payments, and adjustments. Transfer calls to other department personnel as appropriate.
• Follows best practice to ensure timely follow-up on all accounts and verifies accurate reimbursement from payers.
• Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquires and concerns (i.e. "correspondence"), and works to develop and maintain positive relationships with payers.
• Uses correct billing codes to ensure proper claim processing. Based on payer error reports, makes appropriate corrections to optimize the electronic and/or paper claims submission process.
• Practices excellent customer service skills by answering patient and third-party payer questions and/or addressing billing concerns in a timely and professional manner.
• Researches denials, correct and resubmit in a timely manner. Assists with formulating written appeals.
• Assists with review and resolution of credit balances.
• Maintains superior understanding of claims management, third-party payer guidelines, state and federal regulations, and all other functions of the job.
• Assures accurate application of payments received and timely processing of refunds.
• Follows department's documentation policy to ensure necessary information is documented in the patient's account. Uses canned and smart text as appropriate.
• Maintains working knowledge of rules and regulations regarding patient status such as Medicare Secondary Payer, Advance Beneficiary Notices, and Important Message from Medicare, Notice of Privacy Practices, Patient Rights, Advance Directives and EMTALA.
• Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest trends in field of expertise.
• Ensures no injuries to self or others by following safe work practices and policies. This includes, but is not limited to: security and safety, understanding of MSDS, equipment, infection control, fire, disaster, safe lifting and body mechanics.
• Ensures self-compliance with organization policies and procedures, as well as labor agreements.
• Ensures the interface with team members and other support groups is conducted in a courteous and efficient manner conducive with the organization's values.
• Conducts self in a professional manner and ensures personal appearance meets the standards necessary to perform the job function while representing the organization.
• Ensures that additional accountabilities, as may be required by management, be handled in a manner necessary to meet organizational standards.

WORK ENVIRONMENT

The professional in this position reports to the Director of Revenue Cycle and works closely with the department professionals and other healthcare professionals in order to provide high quality services to all customers.

EDUCATION & EXPERIENCE

• Education:
• High school diploma or equivalent required.
• Experience:
• 1-2 years of customer service and/or business office experience preferred, ideally in medical setting.
• Minimum one-year of successful, relevant experience in Hospital or Clinic billing.
• Skills/Competencies:
• Demonstrated knowledge and experience with third party payer guidelines, reimbursement, follow-up, and collections.
• Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical terminology.
• Demonstrates competency on equipment listed on department specific checklist.
• Critical thinking skills: Seeks resources for direction, when necessary. Performs independent problem solving. Decision-making is logical and deliberate.
• Performs actions that demonstrate accountability. Exercises safe judgment in decision-making. Practices within legal and ethical guidelines.
• Demonstrates competency in ability to care for customers/patients across the age continuum.
• Bilingual (English/Spanish) preferred.

PHYSICAL REQUIREMENTS

• Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing and pulling. Light physical effort, ability to lift/carry up to 10 lbs. (supplies and equipment).
• Ability to communicate using verbal and/or written skills for accurate exchange of information with physicians, nurses, health care professionals, patients and/or family, and the public.

As a Samaritan professional, you will be asked to commit to being part of a culture grounded in our Mission, Vision, Values, and Strategy that brings service and operational excellence to life each day while creating an exceptional experience for our patients, professionals, physicians, and students. Additionally, how we present ourselves matters, and adherence to our Professional Appearance Policy reflects the pride, respect, and professionalism we bring to those we serve.