Patient Account Representative II (Remote)

Stanford Health Care · United States

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a Stanford Health Care job. A Brief Overview The Patient Account Representative (PAR) is responsible for the timely and accurate processing of insurance balance patient claims in accordance with contracts and policies. The PAR works in various capacities to support the primary goal of the business office to resolve of unpaid, underpaid, denied or unresolved patient accounts. Depending on the specific team, the PAR's focus may be on a mix of various responsibilities from across the Patient Financial Services (PFS) operations. Responsibilities may include:

• Accounts receivable collections and payer follow-up
• Payer clerical and technical denial review and request processing including basic appeals
• Payment posting and batch reconciliation
• Credit balance review and resolution
• Retroactive eligibility and registration
• Underpayment reconciliation
• Client or other special billing

• Responding to requests from the payer, such as providing medical records or other documentation either by mail or via payer portals
• Following up on unresolved patient accounts in Epic by contacting the payer by phone or via the portal
• Resolving claim edits
• Reviewing payer variances and pursuing underpayments to payers
• Reviewing and resolving payer rejections, denials, and performing appeals as necessary
• Electronic or hardcopy claims editing and submission to payers
• Recognizing potential trends and escalating them as appropriate
• Posting payments in Epic, as well as related adjustments
• Resolving credit balances
• Completing basic charge corrections

• Meets weekly individual productivity goals and standards while following planned priorities as set by the Team Manager
• Can maintain professional communication with various PFS staff, payers, and patients regarding the billing of services.
• Ability to follow oral and written instructions and interpret institutional and other policies accurately
• Ability to communicate clearly and professionally both verbally and in writing
• Ability to maintain confidentiality of sensitive information
• Ability to perform basic mathematics
• Ability to plan, prioritize, and meet deadlines
• Ability to work effectively with individuals at all levels of the organization
• Knowledge of accounts receivable software systems and medical billing operations
• Familiarity with medical reimbursement policies and procedures and medical terminology
• Knowledge of payer landscape, including Medicare, Medicaid, Workers’ Compensation, Managed Care, or other Commercial insurance

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination