Patient Accounts Representative II
- Job Title
- Patient Accounts Representative II
- Job ID
- Washington, DC 20060
- Other Location
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nation’s only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Patient Account Representative II who will embrace our reach and historic tradition of excellence. If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.
The Patient Account Representative:
- Verifies insurance coverage, benefits and calculating financial obligation for the provision of providing financial counseling to patients.
- Enters/updates patient, insurance, contract, revenue, and/or reimbursement data into one or more applications.
- Prepares and submits hard-copy billing claim packages, including collecting of all necessary materials for proper claim creation/modification; making payor-specific data changes as required for accurate and timely billing.
- Prepares and submits specialty billing claim packages, including collecting of all necessary materials for proper claim creation/modification; making payor-specific data changes as required for accurate and timely billing; then monitors subsequent payor processing and reimbursement performance to ensure agreement/contract compliance. (Specialty billing includes but is not limited to: chemotherapy, research grants, special programs, and secondary/tertiary health plan.)
- Monitors subsequent payor processing and reimbursement performance to ensure agreement/contract compliance.
- Effectively collaborates through verbal and written forms of communication with patients and/or their family members, third-party payers, or attorneys on matters involving billing and the pursuit of payment for services rendered.
- Utilizes HUH payer contracts to effectively & efficiently calculate expected reimbursements.
- Performs routine arithmetic calculations associated with revenue billing, computing expected payor and patient reimbursement amounts, as well as contractual adjustment amounts for individual accounts.
- Establishes and/or monitors self-pay financial plans; working with vendors as necessary where patients may qualify for financial assistance.
- Collaborates with Clinical Care or Social Work to obtain necessary materials for accurate and timely billing; or for the purpose of supporting denial prevention & management team. Performs all necessary claim review and research to prevent claim delay as required for accurate and timely billing.
- Reviews claims having incorrect or missing patient data, facilitates in the correction/addition of missing account data for the purpose of submitting an accurate and timely claim; subsequently initiates and follows through on remedial actions with supervisor to develop solutions that prevent future occurrences when errors are identified as being chronic.
- Review and correct claim errors occurring on electronic claim scrubber system as defined by departmental guidelines; Monitor error frequency with immediate supervisor as remedial actions are developed and executed with error’s root cause.
- Reviews and corrects all necessary items reflected in electronic billing/rejection reports or online claim status query results, delaying a third-party payor’s processing of claim(s); Subsequently initiates and follows through on remedial actions with supervisor to develop solutions that prevent future occurrences when errors are identified as being chronic.
- Reviews and resolves credit balances accurately; Monitoring and reporting to immediate supervisors concerns with out-of-the-ordinary circumstances for investigation.
- Performs payor remittance to reimbursement posting reconciliation and reimbursement posting corrections; ensuring reimbursement consistent with payor contractual/agreement terms before performing adjustments and/or billing of patient responsibility.
- Performs manual posting of payments and necessary research when electronic posting is not applicable. (i.e. lockbox, payment posting batch failures, unidentified payments.)
- Receives and responds timely to internal/external phone calls, correspondence, and inquiries related to patient accounts.
- Performs internal/external phone calls, drafts correspondence, and makes inquiries related to account(s) as required for accurate and timely billing.
- Prepares and maintains supportive data and documents on all required activities within hospital system as defined by departmental guidelines.
- Promotes adherence to the Health Sciences Compliance Program, the Howard University Code of Ethics, and the Health Sciences Standards of Conduct.
- Attends annual and periodic mandatory Compliance Program training including the Health Insurance Portability and Accountability Act (HIPAA) Privacy training.
- Participates in activities that promote adherence to federal healthcare program requirements.
- Actively participates in Health Sciences Compliance Program activities.
- Adheres to the requirements of the HIPAA Privacy Policies and Procedures.
- Maintains confidentiality of patients, families, and staff.
- Ability to establish and maintain effective and harmonious work relationships with staff, physicians, Hospital and University officials, and the general public.
- The employee is expected to achieve appropriate Hospital performance and productivity standards as established.
- The employee will perform other duties that further the customer service needs of the department, such as answering phones, greeting and escorting patients, and administrative and clerical duties upon demand.
- Assumes other duties and responsibilities that are related and appropriate to the position and area.
- The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
- High School Diploma or General Equivalency Diploma (G.E.D.)
- At least 5+ years of experience in billing and collections required
- Acute Care Facility experience (IP Stay collection, DRG Reimbursement, Medicare & Medicaid payer experience) required
- Experience hospital environment required
- Ability to pass the Patient Financial Services Proficiency Test by 80% or more; OR Possess and retain throughout employment certification as a Certified Patient Account Representative – CPAR (HFMA) or Certified Revenue Cycle Specialist (CRCS-I (AAHAM)).
At Howard University Hospital our job is to care for you. We do this by offering:
- Work life balance
- Recognition and rewards for professional expertise
- Competitive, comprehensive benefit plans offered (including health, disability, vacation, sick leave, and 403B retirement plan)
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
Must be able to walk, sit, lift (12-25 lbs.), reach, handle, write, type, speak, hear, see (depth perception), calculate, compare and evaluate, for extended periods of time.
- Required Skills
High School Diploma or General Equivalency Diploma (G.E.D.) Requires 2-3 years of experience in Hospital Billing and Collections environment; and should be able to pass the Patient Financial Services Proficiency Test by 80% or more; OR Possess and retain throughout employment certification as a Certified Patient Account Technician – CPAT (AAHAM), Certified Patient Account Representative – CPAR (HFMA), or Certified Revenue Cycle Specialist (CRCS)