About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Patient Account Representative II
SUMMARY:
Under general direction, the Patient Account Representative (Denials) is responsible for completing tasks associated with specific assignments. Specific job responsibilities will be in customer service, collections, cash posting, billing, etc. as assigned by CBO Management. Patient Account Representative is expeced to perform assignment tasks within the quality and productivity standards assigned to position responsibilities.
Essential Functions and Responsibilities:
- Completes all assigned tasks and responsibilities of Patient Accounting Representative accurately and in a timely manner.
- Responds promptly, professionally and courteously to all customers’ needs.
- Contributes to continuous quality improvement efforts.
- Completes tasks accurately and timely.
BILLING: Responsible for billing hospital and physician claims, for inpatients and outpatients treated in the hospital and clinic, on behalf of the patient, within insurance time filing limits.
- Interprets third party requirements and appropriately bills for facility and physician services within time filing requirements.
- Performs necessary maintenance to patient accounts in the billing and claims editing systems.
- Responds timely to all patient and commercial inquiries either by phone or by written correspondence regarding patient accounts.
- Contacts insurance companies regarding unreleased and unprocessed bills.
- As assigned, Patient Rep will be responsible for developing relationships and working with respective vendors in a timely and professional manner.
- Works with other departments and insurance companies to resolve bill/claim edits.
FOLLOW UP: Responsible for follow-up with third party payors for inpatients and outpatients treated in the hospital and clinic necessary to obtain payment and/or a resolution of patient accounts within insurance time filing limits.
- Performs necessary maintenance to patient accounts in the hospital and claims editing systems.
- Responds timely to all patient and commercial inquiries either by phone or by written correspondence regarding patient accounts.
- Contacts insurance companies regarding outstanding insurance bills.
- Follows-up on Age Trial Balance Report monthly.
- As assigned, Patient Rep will be responsible for developing relationships and working with respective vendors in a timely and professional manner.
- Notify Analyst of edits that needs to be built and Denials Rep for denial trends.
DENIALS REPRESENTATIVE: Responsible for researching, investigating and reducing denials in both quantity and dollar amount.
- Investigate denial trends brought to them by other representatives to prevent future occurrence of denial.
- Research trends and accounts using assigned tools to reduce overall denials.
- Attend monthly Denials meetings, participating and providing material as needed to reduce denial.
- Provide Denials leaders and Denial responsible department need the tools they need for denials meeting.
- Serves as the Denials point person for all hospital and clinics.
- Associate Degree in Health Care, Finance or related area. Equivalent combination of education and relevant experience may be accepted
- Two to three years’ experience in finance and/or revenue cycle functions
- Proven skills in Microsoft Office, specifically Excel and Word, Window based applications, and 10 key calculator with high level of quality outcomes
- Working knowledge of CPT, HCPCS, and ICD-10
- Three years’ experience in hospital financial or patient service.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
