Patient Account Representative, Hospice Outpatient- PD/Days
Employment Type
: Full-Time Industry
: Miscellaneous
Job Responsibilities
* 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
Job Functions:
* 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
* Perform other duties as assigned