Position Summary:

Account Receivable duties include, but are not limited to: Opening mail, preparing deposits –making sure they balance, posting electronic payments, reviewing denied insurance claims and assigning to proper person, and filing and/or scanning insurance explanation of benefits. Position will also be responsible for answering billing questions whether in person or by phone and assisting other staff with third party-payer denials.

Patient Financial Representative duties include, but are not limited to: Managing patient accounts following guidelines for disposition of unpaid services; i.e. establishing payment arrangements with patients, intervening with third party payers, assigning past due accounts to collection agency or discharging to charity care/uncollectable. Answer incoming calls from patients, third party payers, and attorneys requesting information on their account. Knowledge of medical billing/collection practices, insurance procedures and practices, and federal, state, and local legal and regulatory provisions that relate to collection activities. Submit and follow up with commercial insurance claims.

Other duties as assigned.

Education/Experience:

Minimum of high school education, however, some trade course classes in accounting, business and communications would be very helpful in this position. Previous experience in medical billing preferred. Computer skills essential.

Required Credentials (Licensure, Certification, or Registration):

None required. 

Employment Variables:

Work is performed in an office environment. Work hours vary according to the workload and supervisory scheduling. Rubella titer will be drawn initially as well as TB skin testing upon hire and immunization required if no past exposure or indication of immunization. Required to wear name tag provided by Winner Regional Health and to dress in a professional manner.

Job Knowledge and Skills:

Ability to read, write, speak and understand the English language. Excellent oral and written communication skills, work with customers and co-workers in a professional manner. Tact and courtesy when dealing with all customers. Able to work with limited supervision. Computer and bookkeeping experience along with office machine/equipment knowledge. Must be able to pay attention to detail. Must be able to concentrate and work on tasks amidst distractions. Must exert self-control in difficult situations. Consistently projects a positive image of the facility. 

Direct Supervisor:

Business Office Manager

PART II: CODE OF CONDUCT

Honesty We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions.

Expertise We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available.

Approachability We will be non-judgmental, friendly, and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others.

Respect We will be understanding and sensitive to others’ feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others’ feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another’s name.

Teamwork We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.

PART III: ESSENTIAL FUNCTIONS

Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.

Accounts Receivable

• Records payments and adjustments made by patients and insurance companies.  
• Changes the financial class to next appropriate class after payment is made.  
• Researches amounts denied by insurance companies or bring it to the attention of the appropriate person working on the claim.  
• Makes sure the deposit balances before it goes to the bank.  
• Posts electronic payments in a timely manner and follows up on any claim that was denied or paid incorrectly.
• Scans or files EOB’s from insurance companies so they can be easily retrieved by other office employees.
• Answers billing questions from patients by phone or in person.

Research Skills

• Uses resources available (i.e. Internet, Newslines, web conferences) to learn about new or updated payroll or accounts receivable procedures.  
• Participates in department meetings within the business office and attends other informative meetings as instructed by the office manager.  
• Retains information for daily and future use.  

Organization and Communication Skills

• Demonstrates critical thinking skills to manage day to day basic operations or has the ability to seek assistance when needed.  
• Works steadily, efficiently, and shows consistent attention to the details of the work.  
• Shares appropriate information and knowledge with coworkers.

Technology Implementation

• Uses software system for daily operations.  
• Attempts to learn new ways to utilize our computer software (i.e. different reports).  
• Reduces paper printouts to prepare for paper-light billing.

Collection Services

• Identify delinquent accounts, aging period, and payment sources. Perform collection actions including contacting patients by telephone and resubmitting claims to third party payers.  
• Evaluate patient financial situation and establish payment plans.
• Send collection notices to patients not meeting established payment commitments.
• Initiate and monitor the application process for provision of Charity to qualified agency, make recommendation to Office Manager and CFO, and prepares information to notify collection agency.

Flex Spending

• Monitor employee flex spending and enforce policies to issue checks to employees for reimbursement.
• Records deposits and issues checks to be signed as requested from the employee.
• Balance flex-spending account each month.

Claims Processing Clerical Skills

• Submit insurance claims in a timely manner and fool compliance with each payer’s billing procedures.
• Follow up on denied or unpaid claims by running aged insurance lists.
• Make adjustments to claims that are billed incorrectly and brings continuous errors to the attention of the Office Manager and/or appropriate department.

PART IV: COMPLIANCE

Compliance

• Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position. 
• The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Chief Executive Officer.

PART V: PHYSICAL AND MENTAL REQUIREMENTS

General Activity

In a regular workday, employee may:

• Sit 2-3 Hours at a time; up to 8-10
• Hours during the day
• Stand 1 Hours at a time; up to 0-2
• Hours during the day
• Walk .5 Hours at a time; up to 1
• Hours during the day

Motion  

Employee is required: (In terms of a regular workday, "Occasionally" equals 1% to 33%, "Frequently" 34% to 66%, "Continuously", greater than 67%.)

• Bend/Stoop Occasionally
• Kneel, Duration 30 sec Occasionally
• Squat Occasionally
• Balance Occasionally
• Crawl, Distance Occasionally
• Twist Occasionally
• Climb, Height Occasionally
• Keyboarding/Mousing Frequently
• Reach above shoulder level Occasionally

Physical Demand

Employee’s job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee’s job requires a pushing/pulling force to move a load (not the weight of the load). 

Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

• Sedentary
•  Occasionally 10 lbs. 
•    Frequently Negligible
•    Constantly Negligible

Sensory Requirements:

 Yes/No Explanation (if Yes)

• Speech Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. 
• Yes
• Ability to exchange information with others on the phone. Extensive interactions with customers, co-workers and supervisors either in person or via telephone.
• Vision (VDT) Are there specific vision requirements for the job?
• Yes
• Must be able to edit and proof work and to discern small print and a variety of handwriting. Must be able to operate office equipment.
• Hearing Ability to receive detailed information through oral communications, and to make fine discriminations in sound; i.e., making fine adjustments on machine parts, using a telephone, taking blood pressures. 
• Yes
• Vital for communications with other staff directly or via telephone.

Environmental Factors

Yes/No Explanation (if Yes)

• Working on unprotected heights No     
• Being around moving machinery No     
• Exposure to marked changes in temperature and humidity No     
• Driving automotive equipment No 
• Wearing personal protective equipment No     
• Exposure to atmospheric conditions (i.e. fumes, dust, odors, mists, gases, or poor ventilation) No     
• Exposure to extreme noise or vibration No     
• Exposure to blood, body fluids and waste No     
• Exposure to radiation No     
• Exposure to other hazards (i.e. mechanical, electrical, burns, or explosives) No

Emotional/Psychological Factors

Yes/No Explanation (if Yes)

• Stress: Exposed to stressful situationsYes
• On occasion when information is needed and not available. Working with a variety of co-workers at one time. High accountability. Must be able to establish priorities. Works in an environment of frequent interruptions. May be monitored for productivity and quality.
• Concentration: Must be able to concentrate on work tasks amidst distractions.Yes
• Work must be done accurately. Constant interruptions in a multi-task clerical environment.
• Must exert self-control. Yes
• Must be able to display control and confidence under stress or amidst distractions.

PART VI: JOB RELATIONSHIPS

Supervises

1 No supervisory responsibilities

0 Supervisory responsibility

# Direct Reports:       

# Indirect Reports:       

Age of Patient Populations Served 

• 0 Neonates: 1-30 days
• 0 Infant: 30 days - 1 yr
• 0 Children: 1- 12 yrs 
• 0 Adolescents: 13- 18 yrs
• 0 Adults: 19- 70 yrs
• 0 Geriatrics: 70+ yrs
• 1 All
• 0 Not applicable

Internal Contacts 

• 1 Patients
• 1 Providers: (i.e. Physicians, Therapists, Social Workers)
• 1 Staff: (i.e. clinical and administrative support staff)
• 1 Volunteers
• 0 Others:       

External Contacts 

• 1 Patients
• 1 Families/Significant Others
• 1 Providers
• 1 Vendors
• 1 Community and Health Agencies
• 1 Regulatory agencies
• 1 Other: Job Applicants