PATIENT ACCOUNT REP I CORPORATE

Overview

 

 

 

 

Patient Account Representative - Insurance Claim Follow-Up

Full-Time, 80 Hours Per Pay Period, Day Shift

 

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

 

Insurance Claim Follow Up Overview:

Seeking detailed oriented candidate with strong problem-solving & verbal-written communication skills, as well as excellent time management.

• Review patient accounts for resolution- check status with insurance company for billed claims that have not processed & determine what may be needed in order for claim for finalize.
• Review accounts with full or partial claim denials to find out root-cause & determine best course of action for proper resolution.
• Responsible for learning & understanding payer rules, as well as state/federal guidelines.
• Responsible for prioritizing & completing work per the department’s productivity & quality standards.
• Responsible for facilitating communication between insurance company and the patient to resolve issues holding up claims processing, such as: incorrect demographic information or coordination of benefits.
• Responsible for facilitating communication between other Covenant departments in order to correct any issues with billed claims to ensure correct billing and proper claim processing.

Position Summary: 

This position has the responsibility of working patient accounts as defined by the department established policies and procedures under the Manager and Supervisor within the department. Specifics and volume of work is defined by the functional area within the Business Office that the employee is assigned. All work shall be completed in a timely and accurate manner. 

 

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

Responsibilities

• Assists Supervisor to recognize and identify issues pertaining to the working of accounts.
• Demonstrates the ability to handle varying tasks as well as understanding and interpreting procedures relative to the revenue process.
• Demonstrates knowledge of State and Federal regulations, HIPAA guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance.
• Recognizes situations, which necessitate supervision and guidance, seeks appropriate resources.
• Adheres to established departmental policies and procedures, objectives, process improvement initiatives, safety, environmental and infection control standards.
• Supports, models and adheres to the desired behaviors of the KBOS constitution and Covenant Health for integrity which are; hold others accountable for living the values and behaviors, protect confidential information, deal with difficult issues honestly, directly, respectfully and tell the truth.
• Demonstrates an ability to understand the payer requirements of insurance carriers
• Demonstrates an understanding of all patient information from the facilities and the specifics of each follow-up to ensure appropriate reimbursement is received.
• Professionally deals with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Performs specific functions relating to collection of patient accounts.
• Supports, models and adheres to the desired behaviors of the KBOS Constitution for quality which are; celebrate and reward successes, seek out better ways to do our job, set improvement goals and standards striving to meet or exceed them, participate in forming and being part of work teams when necessary and do not say "It's not my job".
• Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Consults and works collaboratively with Supervisors, Co-workers, Department Manager, and other facility personnel, effectively perform