Senior Patient Account Representative

Job Description

Monitors the activities and performance of physician practices to ensure that billing related functions are performed in an efficient manner consistent with department policies and procedures.

Job Responsibility

• Interfaces with physicians and administrators to ensure financial growth and stability; apprises physicians of new and revised procedures.
• Monitors accuracy of fee structure and reimbursement payment schedules from third party payers, all cash payment deposits and refunds.
• Acts as resource person for resolution of complex billing situations.
• Guides billing/clerical staff regarding billing and office/clerical functions.
• Coordinates clinical documentation requests to business office to ensure timely appeals.
• Develops and implements policies and procedures to facilitate billing and maximize case collections.
• Reviews and recommends improvements for financial management of each billing area.
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

• Associate's Degree required, or equivalent combination of education and related experience.
• 3-5 years of relevant experience, required.

Preferred Experience

• In-depth knowledge of Medicare and Medicaid billing regulations, guidelines, and compliance requirements (e.g., medical necessity, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs)
• Familiarity with common commercial payer policies and reimbursement methodologies.
• Coding Systems expertise in ICD-10 and HCPCS codes
• Strong understanding and application of CMS and AMA CPT guidelines
• Understanding of Modifier Usage and correct application of CPT/HCPCS modifiers.
• Knowledge National Correct Coding Initiative (NCCI) edits and their impact on claims
• Ability to analyze large datasets (e.g., claims data, denial trends) to identify patterns, root causes of errors, and areas of revenue leakage or opportunity.
• Proficiency in using tools like Excel for data manipulation and analysis.

*Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).