Patient Account Representative-PD/Days

Location: 
SMMC-SMMC Hospital
Schedule: 
Per Diem
Shift: 
Variable
Job Listing: 
SAD002111
Administrative, Clerical
Essential Functions and Responsibilities of the Job
  • Ability to submit Medicare, Commercial, and private pay claims in a timely fashion
  • Demonstrates ability to precisely review and calculate all Medi-Cal, Medicare, Cal-optima and managed care payments to ensure accurate reimbursement
  • Demonstrates ability to research and/or follow up on insurance refunds to ensure accurate account balances
  • Monitors, Pays, Updates all Invoices from different vendors. Document appropriately in the Hospice/Health system all correspondences and other transactions in interacting with Accounts Payable and Vendors
  • Ability to complete end-of the month closing and statistical reports
  • Demonstrates ability to monitor and analyze Accounts Receivable (A/R) to ensure minimal number of days in A/R
  • Ability to verify insurance coverage for all payer types for patient admissions. Makes written and or verbal inquires to third party payer to verify insurance benefits, eligibility and insurance status
  • Obtains and tracks all authorizations for home health and hospice patients
  • Ability to be at work and be on time
  • Ability to follow company policies, procedures and directives
  • Ability to interact in a positive and constructive manner
  • Ability to prioritize and multitask
Qualifications: 
Essential Job Outcomes
  • Reviews and identifies all Medicare, Medi-Cal, Cal-Optima and managed care payments accurately on a daily basis
  • Calculates Medicare, Medi-Cal, Cal-optima, and Managed care adjustments accurately and in a timely manner
  • Assess denied services and apply contract knowledge to determine proper preventive measures
  • Identifies insurance refunds accurately and sends Inquiries to insurance company in a timely manner
  • Accurately documents telephone calls in MCHPS system and answers Correspondence in a timely manner
  • Process and pay all invoices in a timely manner while effectively interacts with A/P staff to keep records and up to date
  • Complete end-of-month closing and statistical reports and ensure that charges and payments are balanced and Process additional development requests (ADRs)
  • Bill Medicare, Medi-Cal and all private payers in a timely manner while maintaining low Accounts Receivable days
  • Verifies insurance for all Payers types, for all homecare and hospice admissions and documents in EMR
  • Obtain and track all necessary Pre- certification and pre-authorization from all payer types and document in EMR
  • Functions as a liaison between insurance case manager, clinician and the clinical supervisor
  • Ensure timely, accurately filing of All NOEs in to DDE within timely filing assigned by CMS
  • Ability to be at work and be on time and follow company policies, procedures and directives
  • Ability prioritize and multitask while maintaining a positive and constructive manner
  • Other duties as assigned
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