Description

JOB TITLE:

HH Patient Accounts Representative

DEPARTMENT:

Home Health & Hospice

PAYGRADE:

1307

SUPERVISOR: 

HH/H Manager

USUAL HOURS OF WORK:

8 am - 4:30 pm

APPROVED BY:

Administration

USUAL DAYS OFF:

Saturday and Sunday

STATEMENT OF PURPOSE

The Home Health Patient Accounts Coordinator is responsible for all receptionist and clerical duties of the agency, in addition to a variety of duties related to registration and verification of patient accounts. This responsibility includes obtaining and maintaining insurance authorization, verification of payers, communication of registration and insurance information to department staff, and responsibility of quality review work queues to ensure accuracy and decrease risk of insurance claims denials. This position requires understanding of Home Health and Hospice regulatory requirements including admission criteria, registration process, and payment requirements. 

JOB FUNCTIONS

• Accurately intakes/registers patients for Home Health, Hospice, and private duty services.
• Verifies patient insurance information with insurance companies to determine eligibility, type of coverage, and primary payer upon referral.
• Obtains and enters the pre-authorizations for Home Health and Hospice care.
• Requests additional authorization for existing home care patients as needed throughout episode of care in collaboration with RN Clinical Coordinators and Billing Specialist.
• Utilizes various software applications required by payers to request and obtain authorization for services.
• Acts as a liaison with payers/organizations to ensure efficient and professional exchange of information. 
• Maintains current knowledge of payer requirements and contact information, to include Veteran's Administration, Medicaid, Medicare/Medicare Advantage plans, and all private/commercial insurances.
• Participates in department meetings and daily/weekly huddles as required.
• Assists patients with questions regarding their home health or hospice insurance coverage. 
• Responsible for identified Home Health and Hospice work queues, checking for accuracy and completeness.
• Verifies all registration or admissions of patient accounts are correctly completed.
• Maintains communication and promotes cooperation with Home Health and Hospice staff and other departments as needed in regards to patient accounts, including maintenance of current patient census with authorization information. 
• Responsible for reporting of monthly department statistics
• Works on PC including Microsoft programs (Word, Excel, Outlook). 
• Maintains registration proficiency program.  
• Assists supervisor and manager with quality reviews.
• Performs other related duties as assigned or requested.
• Will assist with departmental policies and procedures.
• Acts as liaison between Home Health Agency and outsourced coding company. Uploads, monitors, and retrieves documents daily.
• Assists billing specialist with preparation of patient charges and billing of Home Health/visits and enters charges into agency and hospital systems as assigned. Assists with computer processing of claims, downloading information, electronic transmission, and hard copy billing, as well as performing internal audit of charge record, and correcting and obtaining any additional information that may be required.
• Prepares, maintains, and disassembles physical patient charts, including labeling and submission of specific documents for scanning into the EMR as assigned. 
• Prepares a variety of statistical and administrative reports, statements, and rosters.  
• Acts as a receptionist by screening telephone calls and visitors for department staff, routing calls and messages appropriately.
• Assists patients, volunteers and visitors as needed.
• Performs clerical functions including recordkeeping and filing. Classifies, sorts, and files correspondence, records, and other documents.
• Prepares data for photocopying, printing, transparencies, etc., collation and distribution.
• Maintains department equipment and supplies.
• Assigns and registers remote patient monitoring units to Clients.
• Provides assignments and direction to volunteers and Home Health Aides who assist in office related procedures.

QUALIFICATIONS/REQUIREMENTS FOR THIS POSITION: (PATIENT ACCOUNTS REPRESENTATIVE)

1. PREPARATION AND TRAINING

High School Diploma with proficiency in medical terminology, medical billing, or home health and hospice experience preferred.

1. WORK EXPERIENCE

One year medical office experience and insurance background is required. Proficiency in a variety of computer programs.

1. ATTENDANCE

Punctual and regular attendance is an essential responsibility of each employee at JRMC. Employees are expected to report to work as scheduled, on time and prepared to start working. Employees are also expected to remain at work for their entire work schedule.

1. ANALYTICAL ABILITY

Maintains office and statistical data that includes math calculations, comparison of numbers, sorting, and filing. Gathers and interprets data used in the processing of claims and billing. Analyze and compile information from different sources. Must have a high level of accuracy in claim processing to avoid errors in billing. Good organizational skills.

1. RESPONSIBILITY FOR MAKING DECISIONS

Works in accordance with established department and hospital policy. Non-routine problems are referred to the Home Health Director. Analyze and compile information from different sources. Independent judgment required.

1. CONTACTS WITH OTHERS

Requires social sensitivity and the ability to communicate effectively with the public and employees who frequent the Home Health and Hospice office.

1. SUPERVISING THE WORK OF OTHERS

None.

1. RESPONSIBILITY FOR WELFARE OF OTHERS

Has direct contact with employees. Frequent phone contact with patients requiring tact and effective communication skills.  

1. MENTAL/VISUAL EFFORT

Must be able to concentrate and avoid distractions. Visual acuity required for computer work. Must be able to speak and write the English language in an understandable and legible manner. Must be in good general health and demonstrate emotional stability. Work requires effort normal to an office environment; requires flexibility due to broad scope of duties.

1. WORKING CONDITIONS

Climate controlled and well-lit standard office. Must be able to work with frequent interruptions. Participates in and complies with JRMC Safety Management program. Maintains knowledge of and observes Standard Precautions. OSHA Job Classification: This position is defined as a Category II: Employee has negligible exposure to bloodborne pathogens.

1. PROMOTION

No formal line of promotion.

1. BACKGROUND CHECK

Background check is required for this position.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required to personnel so classified.

Requirements

EMPLOYEE REQUIREMENTS

• Standing - Frequently
• Walking - Frequently
• Sitting - Rarely
• Hands and Finger Dexterity - Continuously 
• Reaching with Hands and Arms - Continuously 
• Climbing - Rarely
• Stooping/Kneeling/Crouching/Crawling - Continuously 
• Hearing/Listening - Continuously
• Tasting or Smelling - Rarely
• Working Inside - Frequently
• Working Outside - Frequently
• Working in Extreme Heat - Frequently
• Working in Extreme Cold - Frequently
• Working with Hazardous Materials - Rarely
• Noise - Occasionally
• Working in Dirt/Dust - Frequently

LIFTING:

• Up to 10 pounds - Occasionally
• Up to 25 pounds - Rarely
• Up to 50 pounds - Rarely
• Up to 75 pounds - Rarely
• Up to 100 pounds - Rarely
• Over 100 pounds - Rarely

CARRYING:

• Up to 10 pounds - Occasionally
• Up to 25 pounds - Rarely
• Up to 50 pounds - Rarely
• Up to 75 pounds - Rarely
• Up to 100 pounds - Rarely
• Over 100 pounds - Rarely

PUSHING:

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Rarely
• Up to 75 pounds - Rarely
• Up to 100 pounds - Rarely
• Over 100 pounds - Rarely

PULLING:

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Rarely
• Up to 75 pounds - Rarely
• Up to 100 pounds - Rarely
• Over 100 pounds - Rarely