Senior Account Representative - Home Infusion Pharmacy (0.5 FTE, Days)
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Finance & Accounting
0.5 FTE, 8 Hour Day Shift
At Stanford Children’s Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
The Senior Account Representative is responsible for reviewing, and verification of referral intake information entered into the computer to include accurate insurance information and authorization. The account representative prepares and submits claims to appropriate payer for reimbursement of services. This includes direct data entry, manual billing, and follow-up on collections. The account representative is also responsible for maintenance of accurate pricing in the computer system. The account representative will review payments and DSOs to assure appropriate payments have been reviewed and posted and follow-up on any discrepancies with payer.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
• Adjusts and corrects service dates and charges. Prepares claims for billing including obtaining all supportive documentation such as prescriptions, progress notes, lab reports, treatment authorizations and other information which may be required by third party payers to reimburse for services.
• Assists billing analyst with reconciliation of general ledger for accounts receivable, lock box, cash, and entry procedures. Prepares reports as needed from data collected to assist the managers in managing day to day operations and costs. Assists in the generation of monthly charges and preparation of revenue reports for Financial Services each month.
• Assures all billing and reimbursement practices meet all Federal, State, and accrediting organizations, laws, and regulations.
• Creates and maintains a spreadsheet for write-offs for management team follow-up.
• Enters and/or reviews the computer entries for accuracy of: Insurance Information, Dates of Service, Physician Orders, Diagnosis, CPT/Procedure Codes, Insurance Authorization and Statement of Medical Necessity, Benefits and Patient Financial Responsibility.
• Follows-up on any denials or reductions of anticipated reimbursement. Follows-up on all accounts over 45 days old via phone call and rebills as necessary on a monthly basis. Appeals denials when appropriate. Responds to requests by payers for additional and supportive documentation.
• Maintains binders of contracts and references as needed for proper account adjustment information. Makes patient billing charts and files documents as needed.
• Meets with patient or takes phone calls from patients to assist in the resolution of their accounts. Prepares and sends financial responsibility statement to patients. Answers and triage phone calls from patients.
• Receives explanation of benefit. Reviews for accuracy of payment based on contracted/published reimbursement rate.
• Reconfirms insurance and patient demographics and review the insurance and/or claim notes for any changes in current authorization. Documents changes as appropriate.
• Reviews claims for accuracy of charges, dates of service, procedure codes, and proper authorization referring to clinical manager or referral intake if necessary. Mails claims to third party payers as directed under the contract. Uses tracking and tickling tools for any necessary follow-up and monitoring of patient claims.
• Reviews correspondence and properly distributes to appropriate staff for follow-up directly.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: High School Diploma or GED equivalent.
Experience: Two (2) years of progressively responsible and directly related work experience.
Knowledge, Skills, and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
• Ability to establish and maintain effective working relationships.
• Ability to make accurate arithmetic computations.
• Ability to make simple arithmetic calculations and keep simple account records.
• Ability to solve problems and identify solutions.
• Ability to speak and write effectively at a level appropriate for the job.
• Ability to work effectively with individuals at all levels of the organization.
• Knowledge of medical terminology and billing.
• Knowledge of Medicare/Medi-Cal regulations and State and Federal laws.
• Knowledge of Windows-based office software, computers and operating systems.
Physical Requirements and Working Conditions
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.
Compensation is based on the level and requirements of the role.
Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data.
Typically, new team members join at the minimum to mid salary range.
Minimum to Midpoint Range (1.0 FTE): $67,412.80 to $76,471.20
Equal Opportunity Employer