Job Description

The Patient Account Manager manages patient account activity starting with patient information intake through account fulfillment. Responsible for the claims processing and account collection activities of the Patient Accounts department. This position interacts with the insurance companies, patients, family members, health care providers, external medical professionals, legal offices, maintaining patient confidentiality and compliance with HIPAA requirements.

General Office Duties:

1. Supervises the billing and collection process, maximizing efficiencies to best utilize resources. This includes:
2. Hiring, training and developing Patient Account and front desk staff,
3. Determines work schedules to ensure front desk coverage at all locations, ensures work processes are covered during PTO for key functions as needed.
4. Provides direction to staff on matters that arise outside of standard procedure.
5. Establishes and maintains front desk and patient account procedures. May set up initial processes developing workflows, charts, forms, worksheets, or documents and communicates and train staff on procedure.
6. Maintains industry awareness of billing and collection trends, requirements and initiatives and provides direction to adjust internal processes to maintain acceptance and compliance ensuring payment eligibility.
7. Ensures compliance with federal, state, local laws, including but not limited to, HIPAA, Medicare guidelines and laws regulating therapy service delivery.
8. Reviews business processes for improvement recommendations and implements changes to streamline workflow, eliminate issues/redundancies to improve cash flow or profit margin.
9. Facilitates any network contract negotiations and fee analysis.
10. Determines and maintains protocols for the Electronic Medical Records system including establishing protocol, communicating updates and procedure changes to staff, and updating procedures as needed.
11. Performs setup and maintenance of access to payer websites benefit verifications, claims status, appeal processes, and EDI transactions.
12. Monitors claims billing activity including generating and issuing claims, establishing payer connectivity, receiving, and processing payments, reconciling daily front desk collections. Addresses any variances and issues with exceptions to the process.
13. Supervises claims appeal process including participation in Adjudicated Law Review as needed.
14. Monitors patient account collections including issuing statements, reviewing accounts receivable balances, establishing patient payment plans and initiating collection activity. Addresses any variances and issues with exceptions to the process.
15. Processes and approves financial assistance applications.
16. Maintains therapist information for credentialing to network payers’ requirements to ensure therapist eligibility as rendering providers. Maintains therapist information on network payers’ websites to ensure visibility for provider selection.
17. Trains and monitors compliance of physical and occupational therapists on system issues or billing/collection procedures. This may include but not limited to, communicating new billing information, coding, and documentation requirements.
18. Coordinates depositions for therapists including ensuring third party payments.
19. Reviews processes to make improvements whether to streamline processes, eliminate issues/redundancies or improve cash flow.
20. Reviews policies, recommends and implements changes as necessary.
21. Monitors external vendors such as merchant services, collection agency, third party payer, or clearinghouses and recommends changes for performance or cost improvements.

Qualifications:

Must have above average work ethic and dedication to patient success, good communication skills, demonstrated ability to perform detailed and accurate work and perform work independently. Advanced computer skills are required.

Minimum of 3 years claims processing experience in a related industry. Broad understanding of health care billing and payment processes. Must possess the ability to perform all duties with regard to state and federal laws and regulations including maintaining patient privacy in accordance with HIPAA and new regulations as they occur.

On-site position, flexible first shift schedule, Monday-Friday (no eves/weekends). Salary $60-80k, depending on experience, plus bonus potential. Benefits include medical, dental and vision insurance, HRA, FSA, short and long-term disability, life insurance, 401k and PTO/holidays.

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