Job Information
Surgery Care Affiliates Patient Account Representative - Treasure Valley Hospital in Boise, Idaho
Overview
Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.
As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:
We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.
The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.
Responsibilities
A.
JOB KNOWLEDGE
Demonstrates knowledge and ability to bill/re-bill all claims received on a daily basis; notifies Billing
Office Manager of any claims received which cannot be billed on date received.
Maintains current working knowledge of third-party billing requirements.
Maintains general current working knowledge of ICD and CPT coding.
Maintains current working knowledge of the current coverage allowances for assigned payor class.
Demonstrates a working knowledge of procedures to process claims.
Demonstrates the knowledge to complete productivity.
Knows of third-party billing requirements
Knows of ICD and CPT coding
Cognitive/Critical Thinking Skills Required
Uses judgment and problem solving to provide patient assistance in reconciling account balances appropriately.
Performs independent problem solving
Makes decisions logically and deliberately
Performs actions that demonstrate accountability
Exercises safe judgment in decision making
Practices within legal and ethical guidelines
Uses a series of sequential, interdependent decisions concerning the stages in billing and follow-up of
assigned patient accounts
Sets sound priorities for sequencing and completing activities
Is consistently aware of patient safety
Knows how to seek resources for direction, when necessary
Seeks resources for direction, when necessary
B.
PRODUCTIVITY
Ensures accurate and timely billing/re-billing of primary, secondary and tertiary insurance for assigned section of the alphabet within designated payor class.
Maintains proper attendance and punctuality in accordance with hospital policy.
*a. Attends work as scheduled.
*b. Becomes knowledgeable of established productivity goals and strives to surpass the minimum
acceptable goals in his/her daily performance.*c. Performs timely billing of accounts upon completion of coding from Medical Records (B6).
*d. Works systematically and prioritizes tasks.
*e. Demonstrates initiative in completing job responsibilities.
*f. Performs thorough follow-up of unpaid balances.
Follows up on unpaid balances with insurance companies. (Thorough follow-up includes timely processing of referred accounts through remittances, ledgers audit trails, outstanding claims report, telephone and/or written inquiries).
*a. Processes adjustments and/or re-bills accounts.
*b. Completes and thoroughly processes remits within one week from date of receipt (to
include the re-billing of necessary accounts)*c. Processes audit trail reports and re-bills, if necessary, all accounts within one week
from date of receipt.*d. Maintains quantity and quality follow-up on a minimum of 70% of accounts needing
follow-up.Demonstrates knowledge and ability to bill/re-bill all claims received on a daily basis. Notifies Patient Accounts Coordinator of any claims received which cannot be billed on the date received.
*a. Maintains current working knowledge of third-party billing requirements.
*b. Maintains general current working knowledge of ICD and CPT coding.
*c. Maintains current working knowledge of the current coverage allowances for assigned payor class.
Qualifications
High school graduate.
Previous hospital billing/patient accounting, clinical, accounts receivable, medical billing appeals and patient billing and collection experience required.
Demonstrates a working knowledge of ICD, CPT and HCPC codes and the ability to create claims and assess and resolve claim denials.
5 years’ experience preferred working specifically into medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements from payer organizations or from the insurance company side
Strong communication skills, both verbally and in writing
Computer experience
Possess basic knowledge of medical terminology and health insurance billing.
Understands medical insurance contracts, coverages, limitations, and bundled procedures.
Understands third party billing requirements.
Understands Workman’s compensation and liability claims.
Uses analytical problem-solving techniques to reconcile patient balances.
USD $19.00/Hr. USD $29.00/Hr.