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