Patient Account Representative II (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
The Patient Account Representative (PAR) is responsible for the timely and accurate processing of insurance balance patient claims in accordance with contracts and policies. The PAR works in various capacities to support the primary goal of the business office to resolve of unpaid, underpaid, denied or unresolved patient accounts.

Depending on the specific team, the PAR's focus may be on a mix of various responsibilities from across the Patient Financial Services (PFS) operations. Responsibilities may include:

- Accounts receivable collections and payer follow-up

- Payer clerical and technical denial review and request processing including basic appeals

- Payment posting and batch reconciliation

- Credit balance review and resolution

- Retroactive eligibility and registration

- Underpayment reconciliation

- Client or other special billing

The PAR II works primarily in Epic, under general supervision, to perform the full range of duties for assigned class. This role requires a strong working knowledge of systems and processes. A PAR II is expected to resolve standard queries and problems independently and works on assignments that are moderately complex in nature where critical thinking is required.

Locations
Stanford Health Care

What you will do

• Responding to requests from the payer, such as providing medical records or other documentation either by mail or via payer portals

• Following up on unresolved patient accounts in Epic by contacting the payer by phone or via the portal

• Resolving claim edits

• Reviewing payer variances and pursuing underpayments to payers

• Reviewing and resolving payer rejections, denials, and performing appeals as necessary

• Electronic or hardcopy claims editing and submission to payers

• Recognizing potential trends and escalating them as appropriate

• Posting payments in Epic, as well as related adjustments

• Resolving credit balances

• Completing basic charge corrections

Education Qualifications

• High school diploma or GED equivalent

Experience Qualifications

• Two (2) years of progressively responsible and directly related work experience

Required Knowledge, Skills and Abilities

• Meets weekly individual productivity goals and standards while following planned priorities as set by the Team Manager

• Can maintain professional communication with various PFS staff, payers, and patients regarding the billing of services.

• Ability to follow oral and written instructions and interpret institutional and other policies accurately

• Ability to communicate clearly and professionally both verbally and in writing

• Ability to maintain confidentiality of sensitive information

• Ability to perform basic mathematics

• Ability to plan, prioritize, and meet deadlines

• Ability to work effectively with individuals at all levels of the organization

• Knowledge of accounts receivable software systems and medical billing operations

• Familiarity with medical reimbursement policies and procedures and medical terminology

• Knowledge of payer landscape, including Medicare, Medicaid, Workers’ Compensation, Managed Care, or other Commercial insurance

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and bet