Patient Representative (Patient Account Rep 1)

Department Overview

As the Patient Representative you will review accounts, refund patients and insurance companies. Assist Tuality cash team as needed by sorting/dist. mail, scanning refund and other documents as needed into Onbase.

 

In this role your duties will include bill, process adjustments, collect on accounts, and/or perform customer service duties to ensure that monies due University Hospital are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on payor mix, patient flow, and workload fluctuations

Function/Duties of Position

Third party follow-up and collection:

• Within the stratified processing environment, collect assertively and proactively money due OHSU by contacting (through telephoning, emailing, and/or accessing on-line systems) third parties (insurance carrier, various government programs, etc.)
• Provide explanation of charges and additional requested information to the third parties.
• Analyze accounts to determine coordination of benefits, refunds, and denials to insure appropriate resolution of accounts.
• Review billing to determine medical records necessary to provide complete processing of claim.
• Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate follow-up action based on departmental guidelines
• Contact patient/guarantor to resolve issues (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence.)
• Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation.
• Comply with special billing and follow-up requirements regarding adoptions, court holds, motor vehicle and personal injury accidents, and other unique or sensitive accounts
• Work reports of denied claims to trend and report these claims to the department and to our front end partners 
• Work closely with admitting, care management and ambulatory services on the denied claims for resolution and feedback purposes
• Prepare the appeals for selected denials

Billing

• Submit bills that comply with all appropriate regulations, managed care contracts to third party payors.
• Calculate the correct reimbursement of all managed care claim

Other Duties as Assigned

Required Qualifications

• Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office;  OR

   

• Four years of general collection, billing or customer service experience; OR

   

• Equivalent combination of education and experience. 

   

• Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire. Positions outside of Patient Business Services may not require certification.

• Must be able to perform the essential functions of the position with or without accommodation

Preferred Qualifications

• 1 year of recent medical collection and/or billing experience. Work experience must have occurred within five years of the date of hire.
• Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD, spreadsheet construction in EXCEL.
• Familiarity with DRG, CPT, HCPC and ICD-10 coding.

Job Related Knowledge, Skills and Abilities (Competencies):

• Typing 45 wpm
• Ability to use multiple system applications 
• Demonstrated ability to communicate effectively verbally or in writing.
• Demonstrated ability to prioritize and accomplish multiple tasks in a fast paced environment; consistently adhering to defined due dates
• Experience in billing Hospital claims or UB-04 claims.
• Knowledge of and experience in interpreting managed care contracts. 
• Must be able to perform the essential functions of the position with or without accommodation

Additional Details

Benefits:

• Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee
• Two separate above market pension plans to choose from
• Vacation- up to 200 hours per year depending on length of service
• Sick Leave- up to 96 hours per year
• 8 paid holidays per year
• Substantial Tri-met and C-Tran discounts
• Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP)

All are welcome

Oregon Health & Science Univ