POSITION SUMMARY:
The Patient Account Representative performs daily tasks relating to patient insurance claims and payments; works with assigned insurers (such as commercial carriers, Medicare, Medicaid, MaineCare, Workers' Compensation, MVA, etc.).
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Verifies insurance coverage, address and other pertinent information.
2. Reviews and sends paper or electronic claims as appropriate, providing necessary documentation of services.
3. Researches and reprocesses claim denials.
4. Researches outstanding insurance claims.
5. Posts and processes insurance payments and scans insurance checks into bank system.
6. Researches and initiates refund process for patients and insurance companies.
7. Reapplies patient credits.
8. Reviews upcoming scheduled patient accounts for insurance balance issues.
9. Answers questions for patients regarding insurance matters, claims, and bills.
10. Prepare reports as needed.
11. Updates and maintains the Billing office procedure manual, including directions, for all aspects of this position.
NON-ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Provides back up coverage and other functions as needed.
2. Performs other clerical and administrative duties and tasks as assigned.
GENERAL EXPECTATIONS:
1. Be committed to the mission of the Bucksport Regional Health Center.
2. Work as a member of the Business Office team in the performance of duties.
3. Be punctual for scheduled work and use time appropriately.
4. Work in harmonious relationships with all staff, patients, vendors and others.
5. Perform duties in a conscientious, cooperative manner.
6. Perform required amount of work in a timely fashion with a minimum of errors.
7. Be neat and maintain a professional appearance.
8. Maintain confidentiality and protect the Center by keeping information concerning Operations, patients and employees confidential.
9. Participation in community activities as a representative of Bucksport Regional Health Center.
Requirements
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by the Incumbent to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel, including operation of a standard computer keyboard; reach with hands and arms and talk, see and hear; prolonged sitting is required. Eye hand coordination and manual dexterity required. The employee must occasionally lift/move up to 25 pounds, bend, stoop, stretch or crouch. Specific vision abilities required by the job include close vision, distance vision, and the ability to adjust focus.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those the incumbent encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is performed primarily in an office setting. Noise level is usually quiet.
QUALIFICATIONS NEEDED FOR POSITION:
Experience and Skill Requirements: The following experience and skills are considered essential:
- At least one year of experience working in a Business Office required.
- At least one year of experience processing health insurance claims preferred.
- Computer experience using Microsoft Windows and Microsoft Office software products required.
- Ability to establish and maintain effective working relationships with other employees and the public.
- Ability to communicate and present information.
- Ability to read, interpret, and apply policies and procedures.
- Ability to identify problems and recommend solutions.
- Ability to establish priorities and coordinate work activities.
Education Requirements: The following education requirements are considered essential:
- High School diploma or equivalent with emphasis on office and business skills including keyboarding, filing, and multi-tasking, required.
** All requirements and skills are considered to be essential, unless otherwise indicated. **