Decatur Memorial Hospital

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Patient Account Representative - 82510 Business Office

at Decatur Memorial Hospital

Posted: 5/30/2019
Job Reference #: 104601

Job Description

82510 Business Office

Full Time 40 HRS


Work Hours:

Job Details:
  • Summary

    Responsible for billing, following up and denials management on assigned patient accounts
    and financial class.

    Essential Functions and Job Duties

    · Submits claims in accordance with payor requirements/policies/regulations. Reviews
    accounts to make certain that coding and charging match before billing of claim is

    · Reviews denials to determine if the claim can be resubmitted or appealed for payment.

    • Reviews outstanding claims through insurance follow-up schedule. Pursues v
      arious means to obtain timely reimbursement of accounts.
    • Collaborates with other departments to resolve billing issues in a timely manner.
    • Analyzes and processes credit balance report in accordance with established
      guidelines. Identifies when refunds are necessary are follows appropriate
      procedures to process the refund in a timely manner.
    • Works with Customer Service Representatives to address patient billing concerns.
    • Works with Cashiers to address payment posting errors.
    • Identifies necessary adjustments and submits to Coordinator for review/approval.
    • Respond and process incoming correspondence in a timely manner.
    • Maintains current knowledge of payor requirements.
    • Reviews managed care contracts through please check process.
      o Calculates appropriate managed care discounts.
      o Compares insurance EOB with Pcon EOR when problems arise.
      o Professionally works through managed care discrepancies with insurance companies.
    • Performs other duties as assigned.


    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.

    • Knowledge of principles and processes for providing customer and personal
      services. This includes evaluating the needs of the customer meeting quality
      standards for services and evaluation of customer satisfaction.
    • Knowledge of the structure and content of the English language including the
      meaning and spelling of words, rules of composition, grammar, ability to listen
      and communicate effectively.
    • Thorough understanding of computer systems is required.
    • Good keyboarding skills.
    • Able to type at least 50 words per minute.
    • Knowledge of medical terminology is preferred.
    • Uses logic and reasoning to identify the strengths and weaknesses of
      alternative solutions, conclusions or approaches to problems.

    Education and/or Other Requirements

    Required: High school education or equivalent.

    Required: Previous healthcare operations or healthcare insurance experience