Account Representative

Professional/Technical Escondido, California


Requisition ID
32377
Department
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Location
Escondido, California
Union
Not Applicable
Job Type
Full-Time
Shift
Day
Hours Per Shift
8
Hours Per Pay Period
80

Description
  • POSITION NARRATIVE: 

    The Account Representative enters business critical patient information into the Electronic Practice Management system including demographics, insurances, verified charges, and all necessary adjustments. Follows medical group policies and procedures, applicable laws and standards addressed in the Compliance Program.  Account Representatives will also be expected to manage accounts receivables aging and days out for assigned accounts, generate claims, send out patient statements, actively participate in collection procedures, field patient inquiries, research and appeal claim denials, coordinate re-submissions in addition to any and all other task as assigned.  The Account Representative may be responsible for incoming and outgoing calls for the Business Office. Must be responsive to caller’s needs, routes telephone calls to appropriate parties and distributes messages.

     

    ESSENTIAL FUNCTIONS:

     The below is not intended to be an all-inclusive list of essential functions for the job described, but rather a general description of some of the responsibilities necessary to carry out the duties of this position.

    • Answers incoming phone calls promptly in a professional and courteous tone of voice
    • Manages assigned Accounts Receivables
    • Accepts and applies payments to patient accounts
    • Post Payments and moves monies when applicable on patient account
    • Trend and research claim denials to identify root cause
    • Communicates trends to Sr Account Representative or CBO Supervisor
    • Validate credit balances
    • Returns patient calls in a timely manner
    • Gives accurate information to patient regarding their account and balance due
    • Update patients’ demographics
    • Update patient account status
    • Patient follow-up
    • Rebills
    • Insurance follow-up
    • Claims review
    • Review patients’ statements as needed
    • Answer patient insurance inquiries
    • Complete various clerical tasks and help other departments as required i.e. mail out bills/statements
    • Other duties as assigned

    SKILLS, KNOWLEDGE & ABILITIES: 

    • Skills: Excellent internal and external customer service skills with ability to communicate effectively with a courteous tone on the phone and through email with patients, physician office staff, insurance carriers, and colleagues. Proficient computer software skills in MS Office Suite.
    • Knowledge: Knowledge of principles of exceptional internal and external customer service, health plans , medical terminology and insurance authorizations.
    • Abilities: Accurately answer patient and physician office inquiries regarding billing, enter accurate demographic/insurance information in PMS. Ability to manage AR reports in Excel. Must have strong attention to detail. Ability to problem solve and use good judgment. Ability to support mission, vision and values of Arch and make recommendations for improvements.

     

    COMPETENCIES:

    • Functional/Technical Skills, Customer Focus, Compassion, Integrity and Trust, Teamwork, Communication Skills, Action-Oriented, Dependability, Adaptability

     

    REQUIREMENTS:

    • High School Diploma or GED minimum requirement
    • Medical Insurance Billing Certificate highly desirable
    • Proficient in Microsoft Office
    • Previous experience in medical billing preferred

     

    PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  Constantly required to talk or hear.  Frequently required to stand, walk, and sit; may sit for long durations of time.  Frequent use of hands, fingers and arms. Occasionally needs to climb or balance, stoop, kneel, crouch, or crawl.  Occasionally lift up to 20 pounds.  Constantly required to see; review written material, computer screens & phones with the ability to adjust focus.

     

    Language Skills: Must be able to effectively communicate with patients, physician office staff and colleagues via telephone, electronically, and person-to-person; listening and exchanging accurate information, responding to questions, and conveying information.  Ability to read and interpret documents such as patient data.  Ability to write correspondence. 

     

    WORK ENVIRONMENT:  Palomar Health Medical Group maintains a drug free workplace, and smoke free working environment.  Employees are required to successfully pass a pre-employment drug screen.  Smoking is permitted in designated areas outside of Palomar Health Medical Group offices.


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We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.