The Patient Account Representative works with Team Ortho and is responsible for following up on unresolved patient claims; taking the necessary steps to ensure prompt and accurate payment; and responding to and resolving patient inquiries.

Essential Duties and Responsibilities

• Answer telephones and assist patients and others coming into the Team Ortho Clinic.
• Prepare and review patient statements
• Respond promptly to inquiries, concerns and problems related to patient billing.
• Maintain a positive dialogue when working with patients or family members on making financial arrangements to pay hospital bills, including assistance in completing charity applications.
• Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
• Performs concurrent and retrospective reviews on Ortho cases including referrals and prior authorizations, plans available covered services including identifying alternative levels of care that may be covered.
• Obtain prior authorization or pre-certification of services to be rendered as required by Team Ortho.
• Review with managers any issues which may lead to non-compliance or reduced

reimbursement

• Take the appropriate and necessary action to have the claim resolved, including negotiating settlements with the insurance company.
• Addresses prior authorization issues/problems with Director of Sports Medicine and Orthopedics and Business Office.
• Provide support on special projects related to improving the revenue cycle.
• Identify process and system issues and make recommendations to improve efficiency
• Promptly review patient correspondence (letters, emails, etc.) and take the necessary

action.

• Maintain thorough and detailed knowledge of hospital revenue cycle including insurance,

self-pay, and third-party payers.

• Exhibit an understanding of federal, state, and contractual guidelines/regulations as it

relates to Medicare, Medicaid, Managed Care and Commercial Insurance companies to ensure ongoing compliance.

• Demonstrate thorough knowledge of CPSI and Microsoft Office.

• Work with other departments to ensure charges are correct and insurance information and discharge dates are in entered in CPSI correctly and make corrections, if not.
• Must be HIPAA compliant.
• Other duties as may be assigned.

Job Requirements
Education: High School Diploma or GED required. Associates degree preferred. Coding (ICD-10) experience or specialized training in insurance billing and data entry preferred.
Certification/Licensure:
Experience: 2 years of experience in a medical facility, or with health insurance, or related area. Knowledge of function and relationships within a hospital or clinic environment preferred. Advanced customer service skills and experience required. Ability to work in a fast paced environment. Excellent oral communication and customer service skills required. Ability to use proper negotiation techniques to professionally collect money owed by our patients. Ability to build and maintain collaborative relationships with both internal and external clients that lead to more effective communication and a higher level of productivity and accuracy.
Physical Requirements: Ability to sit for long periods of time; occasional standing and walking. The ability to frequently lift up to 50 lbs. Frequent stooping, bending, and reaching. Good visual acuity.

Location: Greene County General Hospital · Team Ortho
Schedule: Full Time, Days

Job Type: Full-time

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