Career Center

OVERVIEW:  The Account Representative is responsible for contacting a high volume of insurance contacts for prompt payment on claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Answer telephone and assist caller (Patient, Family Member or Insurance carrier) with account questions. 
• Verify Insurance through scheduling manager of Practice Management system before patient arrives in office.
• Notify Office if insurance needs updated when patient arrives to the office.  
• Correct and update patient information
• Work mail and address denials or credits until resolved
• Contact insurance carrier to question denial or incorrect payment
• Contact insurance carrier of payment variances.
• Verify with insurance carrier provider profiles are correct.
•  Write up refunds to either patient or Insurance Carrier
• Send self-pay letters to patients.
• Verify and confirm whether a patient needs to be referred to collections.
• Communicate with clinic if patient needs referral authorization.
• Work with patients in need of Financial Assistance.
• Work failed electronic claims in Payer Path to correct for processing.
• Contact outside offices/dialysis centers/hospitals for information needed on claims.
•  Utilize insurance carrier and hospital websites to verify/obtain pertinent information.
• Post write-off as needed (RHC, small balances, bankruptcy).
• Appeal as needed on claims.
• Request Medical Records.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES:

• This job has no supervisory responsibilities.

COMPETENCIES - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Intellectual

• Synthesizes complex or diverse information.
• Collects and researches data.
• Uses intuition and experience to complement data.
• Designs work flows and procedures.

• Identifies and resolves problems in a timely manner.
• Gathers and analyzes information skillfully.
• Develops alternative solutions.
• Works well in group problem solving situations.
• Uses reason even when dealing with emotional topics.

• Assesses own strengths and weaknesses.
• Pursues training and development opportunities.
• Strives to continuously build knowledge and skills.
• Shares expertise with others.

Interpersonal

• Manages difficult or emotional customer situations.
• Responds promptly to customer needs.
• Responds to requests for service and assistance.
• Meets commitments.

• Focuses on solving conflict, not blaming.
• Maintains confidentiality.
• Listens to others without interrupting.
• Keeps emotions under control.
• Remains open to others' ideas and tries new things.

• Speaks clearly and persuasively in positive or negative situations.
• Listens and gets clarification.
• Responds well to questions.
• Demonstrates group presentation skills.
• Participates in meetings.

• Balances team and individual responsibilities.
• Exhibits objectivity and openness to others' views.
• Gives and welcomes feedback.
• Contributes to building a positive team spirit.
• Puts success of team above own interests.
• Supports everyone's efforts to succeed.
• Recognizes accomplishments of other team members.

• Writes clearly and informatively.
• Edits work for spelling and grammar.
• Varies writing style to meet needs.
• Presents numerical data effectively.
• Able to read and interpret written information.

Leadership

• Exhibits confidence in self and others.
• Inspires and motivates others to perform well.

• Looks for ways to improve and promote quality.
• Demonstrates accuracy and thoroughness.

Organization

• Works within approved budget.

• Demonstrates knowledge of EEO policy.
• Shows respect and sensitivity for cultural differences.
• Promotes a harassment-free environment.

• Treats people with respect.
• Keeps commitments.
• Inspires the trust of others.
• Works with integrity and ethically.
• Upholds organizational values.

• Follows policies and procedures.
• Completes administrative tasks correctly and on time.
• Supports organization's goals and values.

• Understands organization's strengths & weaknesses.

Self Management

• Adapts to changes in the work environment.
• Manages competing demands.
• Changes approach or method to best fit the situation.
• Able to deal with frequent change, delays, or unexpected events.

• Is consistently at work and on time.
• Ensures work responsibilities are covered when absent.
• Arrives at meetings and appointments on time.

• Follows instructions, responds to management direction.
• Takes responsibility for own actions.
• Keeps commitments; commits to long hours of work when necessary to reach goals.
• Completes tasks on time or notifies appropriate person with an alternate plan.

• Volunteers readily.
• Undertakes self-development activities.
• Seeks increased responsibilities.
• Takes independent actions and calculated risks.
• Looks for and takes advantage of opportunities.
• Asks for and offers help when needed.

• Displays original thinking and creativity.
• Meets challenges with resourcefulness.
• Generates suggestions for improving work.
• Develops innovative approaches and ideas.
• Presents ideas and information in a manner that gets others' attention.

• Displays willingness to make decisions.
• Includes appropriate people in decision-making process.

• Measures self against standard of excellence.

• Prioritizes and plans work activities.
• Uses time efficiently.
• Plans for additional resources.

• Approaches others in a tactful manner.
• Reacts well under pressure.
• Treats others with respect and consideration regardless of their status or position.
• Accepts responsibility for own actions.
• Follows through on commitments.

• Demonstrates accuracy and thoroughness.
• Looks for ways to improve and promote quality.
• Applies feedback to improve performance.
• Monitors own work to ensure quality.

• Meets productivity standards.
• Completes work in timely manner.
• Observes safety and security procedures.

• Determines appropriate action beyond guidelines.
• Reports potentially unsafe conditions.
• Uses equipment and materials properly.

Language, Math and Reasoning  

• Ability to read and comprehend simple instructions, short correspondence and memos.  Ability to write simple correspondence.  Ability to effectively present information in on and one and small group situations to customers, clients and other employees of the organization.
• Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurements, volume and distance.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.   Ability to deal with problems involving several concrete variables in standardized situations.

EDUCATION, EXPERIENCE, and TRAINING:

• One year certificate from college or technical school; and three to six months related experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS:

• Driver’s License

COMPUTER SKILLS:

• Excellent computer skills in a Microsoft Windows environment.
• Spreadsheet software
• Database software including All Script Practice Management, Acumen EHR

PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The employee must occasionally lift and /or move up to 25 pounds.
• While performing the duties of this job, the employee is regularly required to walk, sit, use hands to finger, handle or feel, reach with hands and arms and talk or hear.
• While performing the duties of this job, the employee is occasionally required to stand or stoop, kneel, crouch or crawl.

VISION REQUIREMENTS

• There are no special vision requirements.

WORK ENVIRONMENT - The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This position works in an environment with moderate noise level. (Examples: business office with computers and printers, light traffic.)