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The Patient Accounting Representative I is responsible for functions within assigned Patient Financial Services (PFS) department. Responsible for accurate and timely action on accounts as it relates to specific responsibilities. Complies with governmental and managed care rules and regulations. Meet department goals as well as productivity and quality standards. Attends and actively participates in training and education.
Job Responsibility:
Reviews Research related charges, directing charges to the proper responsible financial payer source
Applies billing rules to research related charges billable to third-party health insurance payers based on CMS Claims Processing guidelines for Research Services
Invoices study billable services to the correct study and applying the standard applicable discount
Assists Study teams and the CTO in understanding of monthly invoices, answering questions and making corrections of any identified errors
Follows up with Study Groups on outstanding sturdy related billing and balances owed by the study
Assists with traditional follow up for Claims handled in the "normal" insurance billing/follow-up processes for Standard of Care services billed and followed up by the teams that follow up with insurance when questions arise regarding any impacts of billing related to the patient being in a clinical trial where traditional follow up is unable to remedy the denial
Receives and resolves patient billing questions and complaints in a compassionate, courteous, professional and timely manner
Takes actions to resolve issues such as changing insurance, re-filing claims, calling insurance companies or answering questions
Documents actions taken as directed by department policy
Works closely with collection agencies to assure that they receive updated information on accounts
Provides input and assists with implementing departmental planning and process improvements
Demonstrates the ability to effectively communicate with patients and insurance companies regarding sensitive financial matters
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department
Requirements:
High School Graduate
1 or more years of experience in customer service, claims processing, corrections, or billing
Nice to have:
Associates Degree in a related field of study from an accredited college or university