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Patient Account Rep - Patient Business Services, 1.0 FTE, Full-time, IN-DEPT APPLICANTS ONLY

at TheLabRat

Posted: 2/23/2017
Job Status: Full Time
Job Reference #: 689612
Keywords: patient

Job Description

Job Description

Job Title:

Patient Account Rep - Patient Business Services, 1.0 FTE, Full-time, IN-DEPT APPLICANTS ONLY

Company Name:

St. Peter's Hospital

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Employment Type:

Full Time


HELENA, MT, United States


Patient Business Services


Highly Competitive

Shift Hours/ Days:

Monday-Friday 8am to 5pm

Hours/Pay Period:

Degree Required:

None Specified

Job ID:

Date Posted:

Feb 22, 2017

Years Experience:


Note: Please read the complete description below before applying for this job.

Complete Description


Validate and correct billing information prior to claim dropping. Send corrections done to registration coordinator and other billing department within the facility

Do charge corrections received from Medical Records or other departments in hospital, Put comments in what was changed and who asked for the change

Add observation charges hours given by authorization team or Medical Records. Insure carve out times are done accurately. Document hours received in comments

Validate, correct and add value codes, occurrence spans and condition codes per insurance regulations

Monitor and combine related inpatient stays on inpatient stays per insurance regulations

Monitor and combine outpatient services done within 72 hours of inpatient stays for claims per insurance regulations

Monitor and combine same day outpatient services for claims per insurance regulations

Works with Coding department when coding discrepancies are found

Identify and resolves late charges to rebill or do appropriate adjustments per procedures

Contacts patients when clarification of information is needed to successfully bill claim.

Validate and bill all primary and secondary claims on the same day the bill drops. This includes both electronic and hard copy billing

Submits “shadow claims” for non tradition Medicare insurance

Sends appropriate information and attachments with insurance claims when needed.

Work with authorization staff when claims are missing required authorization for services done.

Address all claims on hold or error status in the electronic billing program

Work both paper and electronic denials and additional information requests from Insurance

Work appeals or denials assigned by the Denial Management Lead

Researches and takes necessary action to follow up on unpaid claims by using ATB’s and/or assigned work lists

Works Medicare pending claims in the CMS Direct Data Entry software (DDE)

Analyses insurance payments received to verify account was paid per contract

If it is determined insurance did not pay per contract, contact insurance to get claim reprocessed

Refers correctly paid patient balances after insurance to early out company for self pay billing

Accurately documenting all pertinent activities on the patient account

Timely researches credit balances to determine how to reconcile overpayment. Sends necessary paperwork to finance to send out with refund check.

Reports all Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation

Works patient and insurance correspondence. Respond and document in account and scan documents into patient account.

Prepares and posts all personal and insurance payments to accounts receivable applying appropriate contractual adjustments and discount factors based on contractual and reimbursement methodologies

Coordinates shared payments received with other billing systems. Send all batch lists as one to the finance department.

Add appropriate ANSI denial codes and comments to assure all necessary appeals and post payment follow up can take place

Distribute payment remits, and hard copy denials to billing teams and Denial Management Coordinator

Calls insurance if there is a question where to post payment if not clearly stated on the EOB

Reconciles EFT lists received from the Finance Department to guarantee all electronic funds received are posted

On a daily bases compile list of deposits sent to bank: send copy to bank with daily deposit, keeps copy for next day to reconcile returned deposit receipt. Works will Bank when discrepancies are found to insure all deposits are appropriately accounted for.

Daily send all batch reconciliation information to the Finance department.

Scans all EOB’s into system and creates hardcopy file for original EOB's by day.


Previous work experience in insurance billing regulations and understanding insurance contracts preferred but not mandatory

Knowledge of state and federal regulations as they relate to the billing process preferred but not mandatory

Proficient keyboard skills and working knowledge of computer required.

Good verbal and written communication skills.

EDUCATION: High School diploma or GED required.



Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers.

Possesses interpersonal/communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations.

Open to feedback and a changing environment, which requires flexibility in scheduling and department assignments.

Create, maintain, and promote a respectful work environment consistent with SPH patient and employee satisfaction culture.