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Account Representative Full Time
Vanguard Home Care
4/14/2017 6:12:25 AM
Non Clinical Administrative
The Account Representative II coordinates all activities relating to the collection of accounts receivable, dealing with patients, payers and collection agencies regarding patient bills.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Answers patient inquiries concerning billing and insurance coverage.
Determines the accuracy of all credit balances and refers to the appropriate agency/person for proper refunds.
Determines the accuracy of questionable charges on patient accounts and makes the appropriate adjustments.
Determines and processes all adjustments to HMO and PPO accounts. Assists in expediting payment from the HMO and collects all portions due from the hospital.
Tracks and collects all self pay accounts from the date of discharge.
Determines the patient’s ability to pay and establishes payment schedules. Tracks and collects all delinquent payment accounts.
Tracks all third party (Blue Cross and Commercial) accounts after discharge, assisting the payor in expediting payment while simultaneously collecting on all patients portions.
Determines patients qualifying for Care-Charge. Processes applications, obtains dispositions and prepares final, legal contract.
Tracks all Medicare accounts and collects the patient’s portion after discharge.
Identifies accounts that qualify for Public Aid MANG. Contacts patient and obtains all necessary information.
Works closely with outside agents representing the hospital to assist in securing approval and collecting payments from Public Aid. Collects on all patients spend downs.
Collects on Worker’s Compensation accounts by assisting carriers, attorneys and the Industrial Commission to expedite payment.
Identifies all accounts qualifying for charity according to policies and procedures.
Represents the hospital as a court witness in the collection of bad debt and liability accounts.
Verifies that the correct reimbursement has been received from payors as defined by benefits quoted or contractual agreement.
Maintains a consistent schedule of collection follow up based on the account balance and aging of account.
Maintains working knowledge of all Managed Care Contracts for effective collection follow up.
Corrects all rejections of claims for resubmission via electronic billing system or paper.
Processes internal and external request for additional information to ensure timely payment.
Two (2) to three (3) years of experience with Home Health collection policies and procedures.
Knowledge of billing requirements for Medicare, Blue Cross, Commercial Insurers and HMO’s are necessary in order to effectively counsel patients and collect on their bills.
Knowledge of Public Aid is necessary in order to determine patient eligibility.
Knowledge of the appeals process and procedures for the Court of Claims and Bankruptcy Court is necessary in order to monitor Public Aid billed accounts.
Completion of high school or its equivalent.
Knowledge of patient and hospital legal rights is necessary in order to limit hospital exposure to litigation and ensure proper collections postures.
The analytical ability necessary to determine the accuracy of charges, adjustments and proper collection procedures.
The interpersonal skills necessary to effectively interact with patients and their families, physicians, hospital personnel and outside agencies.
The negotiation skills necessary to deal with and handle conflict with irate patients and/or their families, doctors, attorneys, third party reimbursers, collection agencies and the courts in order to expedite collection payments.
The ability to effectively organize and prioritize work assignments.
Ability to exercise judgment and independent problem solving skills throughout the collection process.
Ability to interpret complex Managed Care Contracts and apply the information with understanding of the financial consequences in follow up with payors.
Ability to operate in an electronic claims processing environment which entails accessing multiple systems for entry, update and retrieval of date
Hospital/Facility: Vanguard Home Care
Job Type: Full-time
Shift Type: Days