Job Summary:

The Patient Account Representative – Collections and Follow up Specialist performs all collection and follow up activities with third party payers; Medicaid; Medicare; Commercial; HMO’s; Third Party Liability; and Workers Compensation to resolve all outstanding balances and secure accurate and timely payment. This position is responsible for supporting and contributing to the team efforts in the achievement of pre-established accounts receivable performance goals of:

Net and Gross Days outstanding in Accounts Receivable Percent of Accounts receivable aged greater than 90 days Credit Balances as a Percent to outstanding receivables Denials Resolution

The Patient Account Representative Collections and Follow up Specialist performs daily activities related to the successful closure of aged accounts receivable:

Perform Account Status and Follow up Resolve Credit Balances Respond to and resolve claim payment denials Correspondence resolution

Duties/Responsibilities:

Performs daily collections activities which would include but are not limited to performing online account status checks and contacting payers to follow-up on outstanding claim balances of assigned accounts in work queue. Clearly documents in the patient account notes, the payment status of the account and/or actions taken to secure payment. If applicable, add a collection task follow up to revisit the account within a specified, appropriate timeframe. Performs required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting posting of account adjustments, requesting an account re bill and any and all other actions necessary to secure account payment. Documents and tracks turnaround time of receipt of any outstanding documents required from external departments. Performs routine audits of assigned individual accounts to resolve all discrepancies in account balances – credit balances, underpayments, inaccurate contractual allowances and performs necessary actions to resolve the account balance. Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others. Inform management of any issues, concerns, questions, and/or changes timely. Exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections. Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans. Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information. Maintains confidentiality in all patient, hospital and physician related information; demonstrate complete discretion when discussing patient information. Performs other duties as assigned

Required Skills/Abilities (Unit Specific):

Excellent organizational skills, detail oriented, and ability to productively multi-task Ability to communicate effectively, both orally and in writing Highly motivated, self-starter with excellent time management skills. Basic knowledge of standard computer programs, including Microsoft Office Suite and application and use of Internet. Knowledge of patient accounting systems. Understands and complies with HIPAA and Protected Health Information rules and regulations.

Education and Experience:

Two years’ experience in healthcare, physician services or hospital outreach preferred. Two + years’ experience directly related to health care claims collections. High School diploma or GED required. Familiarity with healthcare medical terminology and coding. Basic knowledge in the reimbursement guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability. Prefer experience working with insurance companies on insurance claim denials, analyzing insurance denials to find common errors, how to fix them and prevent them going forward. Prefer experience with dealing with insurance companies on a daily basis for claim resolution, answering phones to respond to patient bill inquires, and correcting demographic errors for clean claims.

Pay Range: $18.00-$20.00/hr

Employee salary is based on commensurate experience and other qualifications.

The mission of Oswego Health is to provide accessible, quality care and improve the health of residents throughout Oswego County. As a nonprofit healthcare system that was established in 1881, Oswego Health is proud to continue to be one of Oswego County’s largest employers. More than 1,200 employees spread throughout its 17 locations, work for the Oswego Health system, which includes the 164-bed community hospital with a brand new Medical Surgical Unit, a 32-bed state-of-the-art psychiatric acute-care facility with multiple outpatient behavioral health service locations, The Manor at Seneca Hill, a 120-bed skilled nursing facility, and Springside at Seneca Hill, an independent retirement community. The health system also operates Oswego Health Home Care, the only hospital-based certified home healthcare agency in the County as well as two outpatient centers, including the Fulton Medical Center, offering urgent care, lab, medical imaging, physical therapy, and occupational health services; and the Central Square Medical Center, offering urgent care, lab, medical imaging, and physical therapy services. In addition, Oswego Health includes the Oswego Health captive professional corporation, Physician Care P.C., providing physician services in orthopedics, cardiology, ENT, gastroenterology, breast care, audiology, general surgery, bariatrics, and primary care.

EQUAL EMPLOYMENT OPPORTUNITY

Oswego Health is committed to providing equal opportunity in all employment-related matters, without regard to race (including traits historically associated with race), creed, color, religion, sex/gender, national origin, age, marital or familial status, disability, pregnancy-related condition, sexual orientation, gender identity, gender expression, transgender status, citizenship status, ancestry, arrest/conviction record, military or veteran status, domestic violence victim status, genetic predisposition or carrier status, reproductive health decision making, relationship or association with a member of a protected category, or any other legally protected characteristic. Decisions affecting your position including, but not limited to, recruitment, hiring, placement, promotion, transfer, compensation, benefits, training, tuition assistance, leaves of absence, disciplinary action, layoff/recall, and terminations will be made in accordance with this policy.