Job Description

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

• We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
• We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
• We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
• We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.

The Patient Account Representative will be responsible for thorough and timely patient account follow up with insurances to ensure accurate accounts receivable reporting; to ensure payments by primary and secondary payers and/or self-pay patients are accurate. The PAR will be responsible for daily generation of patient statements. The PAR will be responsible for answering patient calls and correspondence while providing timely, accurate, professional responses and resolution. The PAR will function within the Center’s policies and procedures, support SCA Values, SCA Vision and SCA Mission.

Key Responsibilities :

• Primary functions are credit balance management, patient balance resolution and non-patient (insurance) resolution.
• Accurate and timely follow up and resolution for all accounts receivable.
• Meeting and maintaining cash collection metrics and goals.
• Maximized facility reimbursement.
• Understands each payer contract and will utilize to ensure payments received are correct.
• Understands and can explain the Explanation of Benefits received from any payer.
• Works closely with payer provider relations representatives.
• Has thorough knowledge of ASC Allowable procedures.
• Handles contracted and non-contracted; HMO, PPO, EPO, POS, Worker’s Com., self-pay and third-party reimbursement issues.
• Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures.
• Works all denials and corrected claims collaborating with the biller and/or Business Office Manager, insurance payers and/or patients on past due accounts.
• Follow center policies, procedures, and best practices for resolution and reassignment of accounts.
• Possess basic knowledge of medical terminology and health insurance billing.
• Have ability to communicate effectively with patient, physicians, and other teammates

POSITION PURPOSE

You will work in the Accounts Receivable, or A/R department, within our business office and will be responsible for thorough and timely patient account follow up to ensure accurate accounts receivable reporting; following up with insurance companies and/or third-party payers to ensure payments by primary and secondary payers and/or self-pay patients are accurate and timely. You will:

• Work closely with insurance companies and third-party payers to collect revenue for surgical services performed.
• This role is primarily focused on collecting payments from insurance companies as opposed from collecting from self-payers/individuals.
• Works closely with payer provider relations representatives
• Contacting insurance companies by email and/or phone to collect payments
• Handles contracted and non-contracted, HMO, PPO, EPO, POS, Worker’s Com., self-pay and third-party reimbursement issues.
• Works all denials and corrected claims collaborating with the biller and/or Business Office Manager, insurance payers and/or patients on past due accounts
• Primary functions are credit balance management, patient balance resolution and non-patient (insurance) resolution
• Ensure payments by primary and secondary payers and/or self-pay patients are accurate
• Responsible for thorough and timely patient account follow up to ensure accurate accounts receivable reporting
• Accurate and timely follow-up and resolution for all accounts receivable.
• Meeting and maintaining cash collection metrics and goals
• Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures

This is a fast-paced environment, which requires attention to detail, accountability, teamwork, and professional behavior and a focus that extends to patients, clients and other departments.

• Associate’s Degree or equivalent from a two-year College or technical school; and two years’ experience in a medical office as a patient account representative.
• Candidate MUST HAVE knowledge of medical billing, payer follow-up, payer contracts, appeals, self-pay billing, Medicare and Medicaid billing, AR posting, along with excellent customer service skills.
• Experience in a hospital, outpatient surgery center or related field is a MUST; Computer experience, Excel, Word, Medical Billing Software and Applications; Working knowledge of Medical Terminology.

POSITION REQUIREMENTS

License or Certification:

CPC Certification preferred

Total Education, Vocational Training, and Experience:

• High school graduate. Previous Clinical, Accounts Receivable, Medical Billing appeals and patient billing and collection experience required.
• Demonstrates a working knowledge of ICD, CPT and HCPC codes and the ability to create claims and assess and resolve claim denials.
• 5 years’ experience preferred working specifically into medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements from payer organizations or from the insurance company side
• Strong communication skills, both verbally and in writing
• Possess basic knowledge of medical terminology and health insurance billing.
• Understands medical insurance contracts, coverages, limitations, and bundled procedures.
• Understands third party billing requirements.
• Understands Workman’s compensation and liability claims.
• Uses analytical problem-solving techniques to reconcile patient balances.
• Makes decisions based on experience and knowledge.
• Demonstrates accountability in actions and words.
• Follows industry best practices as outlined.
• Contributes to the growth and health of the department.

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