Patient Advocate Representative (Collector) - Temp to Direct

AIM OF THE POSITION
The Patient Advocate Representative follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner.
POSITION WITHIN THE ORGANIZATION

• Reports to Reimbursement Supervisor
• Cooperates with all departments across the organization
• Organizes activities with Customer Care, Sales, Commercial and external vendors
• Participates in:

– Department meetings
– Project meetings
– Working groups
– Project groups

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.
• Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
• Processes and follows up with patients for copays and deductible amounts due.
• Contacts clients to obtain medical records as needed for submission of a medical appeal or

payer’s review of a claim.

• Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
• Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Manager.
• Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Manager.
• Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
• Interfaces with insurance company representatives, doctor’s offices and hospitals regarding schedule of services and billing inquiries.
• Assists department director in the development of new procedures and systems to enhance productivity.
• Provides account information to the sales force as needed.

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.
KEY CONTACTS
Internal
o This position may interface with all departments within the company.
External
o External Vendors
EDUCATION AND EXPERIENCE REQUIREMENTS
EDUCATION

• High school diploma or general education degree

EXPERIENCE
· 3+ years related experience
KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
Specific Knowledge Required:
Knowledge: Comprehension of a body of information acquired by experience or study.
Skill: A present, observable competence to perform a learned activity.
Ability: Competence to perform an observable behavior.

• Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)
• Must be able to work in a fast-paced environment
• Must have strong organizational skills and attention to detail
• High degree of accuracy
• Manage multiple tasks independently
• Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

• Excellent problem resolution
• Excellent customer service skills
• Outside-the-box thinker

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