Patient Account Representative

Tahoe Forest Health System; Truckee (CA); On-site; USD 33,000 - 45,000; Full time

Job summary

Tahoe Forest Health System in Truckee, CA is seeking a billing specialist responsible for submitting accurate claims and ensuring timely reimbursement from third-party payers and patients. This role collaborates with Revenue Cycle departments and payers on follow-up, denials, and appeals.

The position requires at least two years of recent hospital or physician billing/follow-up experience; Medicare/Medi-Cal billing experience is preferred.

Qualifications

• Two years of recent billing and follow-up experience in hospital and/or physician settings.

Responsibilities

• Examines denied and underpaid claims to determine reasons for discrepancies.
• Communicates with payers via phone and web portals to follow up on outstanding claims and achieve timely reimbursement.
• Provides payers with specific reasons for underpayments and documents patient accounts with status and expected payment amounts.
• Identifies trends in denials and helps develop strategies to reduce accounts receivable.
• Maintains knowledge of payer requirements and HIPAA regulations to ensure billing compliance.
• Keeps payer files updated with contact names, addresses, and essential information.

Skills

Billing expertise

Payer communications

Claims follow-up

Tools

EPIC Hospital Billing

Job description

Bargaining Unit: EA

Rate of Pay: $28.46/hour + DOE

Summary
Responsible for submitting accurate claims, ensuring timely reimbursement from various third-party payers and patients, and confirming proper documentation occurs in the facilities’ billing system. Collaborates with Revenue Cycle departments and third-party payers on efforts related to follow-up, denials, and appeals.

Essential Duties and Responsibilities

• Examines denied and underpaid claims to determine reasons for discrepancies.
• Communicates via phone calls and web-portals, directly with payers to follow up on outstanding claims, resolves payment variances, and achieves timely reimbursement.
• Provides payers with specific reasons for suspected underpayments and reviews denial reasons given by payers. Documents patient account (HAR) with status and expected payment amounts.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing Accounts Receivables (A/R).
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies.
• Keeps current using payer bulletins, coding and billing training and manuals.
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information. Notifies PFS Manager of changes to update other TFH Departments.
• Thoroughly documents all interactions with payers.
• Handles all payer-specific communications, including telephone and email, from payers and departments within the business office.
• Participates in quality improvement efforts on an ongoing basis. Strives to exceed productivity goals as established based on industry standards as approved quarterly by the CFO.
• Demonstrates initiative and resourcefulness by gathering information and examples about issues and helping to document recommendations for system fixes.
• Communicates trends and issues to management and helps to monitor and validate fixes.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Performs other duties as assigned.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities
No supervisory responsibilities.

Minimum Education/Experience
No educational requirement and 2-3 years relevant experience

Required Licenses/Certifications
None

Other Experience/Qualifications

Required:

• Minimum of two years recent billing and follow-up experience in hospital and/or physician clinical areas.

Preferred:

• Prior experience in Medicare or Medi-Cal (Medicaid) billing, EPIC Hospital Billing and/or Physician Billing.
• Knowledge in Critical Access and RHC billing.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.