Patient Account Representative - Billing & Coding, AR, Collections - Treasure Valley Hospital
Company: SCA Health
Location: Boise
Posted on: March 8, 2025
Job Description:
Patient Account Representative - Billing & Coding, AR,
Collections - Treasure Valley
HospitalJOB_DESCRIPTION.SHARE.HTMLCAROUSEL_PARAGRAPHJOB_DESCRIPTION.SHARE.HTML
- Boise, Idaho
- Treasure Valley Hospital
- Billing
- Regular
- Full-time
- 4
- USD $21.00/Hr.
- USD $23.00/Hr.
- 39105SCA Health Job Description 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
The Patient Account Representative will be responsible for thorough
and timely patient account follow up with insurance companies to
ensure accurate accounts receivable reporting; to ensure payments
by primary and secondary payors and/or self-pay patients are
accurate. The PAR will be responsible for answering patient calls
and correspondence while providing timely, accurate, professional
responses and resolution. The PAR will function within the Center's
policies and procedures, support SCA Values, SCA Vision and SCA
MissionYou will work in the Accounts Receivable Department, within
our business office and will be responsible for thorough and timely
patient account follow up to ensure accurate accounts receivable
reporting; following up with insurance companies and/or third-party
payers to ensure payments by primary and secondary payers and/or
self-pay patients are accurate and timely. JOB KNOWLEDGE:
- Credit Balance & Insurance Resolution:
- Resolve patient and insurance account balances (primary,
secondary, self-pay).
- Work with insurance companies to ensure payments are processed
correctly.
- Manage and resolve outstanding claims or accounts in a timely
manner.
- Achieve cash collection metrics and goals set by the
department.
- Accounts Receivable Follow-Up:
- Ensure accurate and timely follow-up on all accounts
receivable.
- Maximize facility reimbursement by working with insurance
providers to resolve issues.
- Denials and Claims:
- Handle denials and corrected claims independently and
collaborate with billing team to resolve.
- Understand payer contracts and utilize them for accurate
billing and reimbursement.
- Customer Interaction:
- Provide professional responses to patient and payer
inquiries.
- Work with patients and providers to explain insurance coverage,
EOBs, and billing issues.ESSENTIAL POSITION REQUIREMENTS:
- Billing & Accounts Receivable:
- Bill and re-bill primary, secondary, and tertiary insurance
claims daily.
- Maintain knowledge of third-party billing requirements and
current insurance coverage allowances.
- Ensure accurate and timely follow-up of unpaid balances,
including processing claims, re-bills, and remittances.
- Work with insurance representatives to resolve denied claims
and adjust accounts as needed.
- Meet productivity goals and follow departmental guidelines for
billing and claims management.Communication & Customer Service:
- Communicate effectively with insurance representatives,
patients, and other staff to resolve issues and ensure proper
reimbursement.
- Notify the Billing Office Manager of any issues or claims that
cannot be billed on the date received.
- Maintain confidentiality and professionalism in all patient and
departmental communications.Problem-Solving & Decision-Making:
- Utilize judgment to resolve complex billing issues and provide
patient assistance in reconciling account balances.
- Handle patient and insurance inquiries independently, using
experience and knowledge to ensure accurate account
resolution.
- Productivity & Time Management:
- Maintain a high level of productivity, ensuring timely billing
and follow-up on a minimum of 70% of accounts needing
attention.
- Prioritize tasks, demonstrate initiative, and meet deadlines
while maintaining accuracy.
- Support team efforts to achieve departmental goals and
contribute to a positive work environment.Compliance & Attitude:
- Adhere to all hospital policies, procedures, and industry best
practices.
- Display a positive, flexible attitude toward change and work
collaboratively with colleagues.
- Demonstrate respect for co-workers, patients, and hospital
procedures, ensuring a professional and respectful
environment.POSITION PURPOSE:
- Work closely with insurance companies and third-party payers to
collect revenue for surgical services performed.
- Collect payments from insurance companies as opposed from
collecting from self-pay individuals.
- Works closely with payer provider relations
representatives.
- Contacting insurance companies by email, website, and phone to
collect payments.
- Manages contracted and non-contracted, Government, Commercial,
Medicare Advantage, Workers Compensation, and self-pay.
- Works all denials and corrected claims collaborating with the
biller and insurance payers and/or patients on past due
accounts.
- Has the ability to calculate and verify insurance coverage
including pre-authorization, patient co-pay and deductibles.
- Coordinate with Physician offices to ensure pre-authorization
is obtained with the appropriate scope for CPT and ICD 10
codes.
- Posts and reconciles payments daily including EFT (835 files)
from insurance and cash and check from insurance and patients.
- Primary functions are credit balance management, patient
balance and insurance resolution
- Ensure payments by primary and secondary payers and self-pay
patients are accurate
- Responsible for thorough and timely patient account follow up
to ensure accurate accounts receivable reporting
- Accurate and timely follow-up and resolution for all accounts
receivable.
- Meeting and maintaining cash collection metrics and goals
- Effectively and independently manages second level
reimbursement issues, contracted and non-contracted denials and
appeals.
- This is a demanding environment, which requires attention to
detail, accountability, and teamwork
Qualifications
License or Certification:
- CPC certification is preferred but not required.
- Associate's degree or equivalent from a two-year College or
technical school; and two years' experience in a medical office as
a patient account representative.
- High school graduate. Previous clinical, accounts receivable,
medical billing appeals and patient billing and collection
experience required.
- Demonstrates a working knowledge of ICD, CPT, HCPC and revenue
codes and the ability to assess and resolve claim denials.
- 1-2 years' experience preferred in medical insurance,
collections, billing accounts receivable, and patient collections,
ideally within a hospital environment.
- Effective communication skills, both verbally and in
writing.
- Understand medical insurance contracts, coverages, and
limitations.
- Use analytical problem-solving techniques to reconcile patient
balances.
- Makes decisions based on experience and knowledge.
- Demonstrates accountability in actions and words.
- Follows industry best practices as outlined.
- Contributes to the growth and health of the department.Total
Education, Vocational Training, and Experience:
- Candidate MUST HAVE knowledge of medical billing, payer
follow-up, payer contracts, appeals, self-pay billing, Medicare and
Medicaid billing, AR posting, along with excellent customer service
skills.
- Experience in a hospital, outpatient surgery center or related
field is a MUST; Computer experience including Excel, Word, Medical
Billing Software and Applications; Working knowledge of Medical
Terminology.
- High school graduate. Previous Clinical, Accounts Receivable,
Medical Billing appeals and patient billing and collection
experience required.
- Demonstrates a working knowledge of ICD, CPT, HCPC, and Revenue
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
- Effective communication skills, both verbally and in
writing
- Possess knowledge of medical terminology and health insurance
billing.
- Understands medical insurance contracts, coverages,
limitations, and bundled procedures.
- Uses analytical problem-solving techniques to reconcile patient
balances.
- Makes decisions based on experience and knowledge.
- Demonstrates accountability in actions and words.
- Follows industry best practices as outlined.
- Contributes to the growth and health of the department. USD
$21.00/Hr. USD $23.00/Hr.
PI635a0b62931b-37248-37082800
Keywords: SCA Health, Boise , Patient Account Representative - Billing & Coding, AR, Collections - Treasure Valley Hospital, Accounting, Auditing , Boise, Idaho
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