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Patient Account Representative - Insurance Claim Follow-Up

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Insurance Claim Follow Up Overview:

Seeking detailed oriented candidate with strong problem-solving & verbal-written communication skills, as well as excellent time management.

• Review patient accounts for resolution- check status with insurance company for billed claims that have not processed & determine what may be needed in order for claim for finalize.
• Review accounts with full or partial claim denials to find out root-cause & determine best course of action for proper resolution.
• Responsible for learning & understanding payer rules, as well as state/federal guidelines.
• Responsible for prioritizing & completing work per the department’s productivity & quality standards.
• Responsible for facilitating communication between insurance company and the patient to resolve issues holding up claims processing, such as: incorrect demographic information or coordination of benefits.
• Responsible for facilitating communication between other Covenant departments in order to correct any issues with billed claims to ensure correct billing and proper claim processing.

Position Summary: 

This position has the responsibility of working patient accounts as defined by the department established policies and procedures under the Manager and Supervisor within the department. Specifics and volume of work is defined by the functional area within the Business Office that the employee is assigned. All work shall be completed in a timely and accurate manner. Positions start on-site, with opportunity for remote work once training is complete and productivity and quality metrics are consistently met.

• Assists Supervisor to recognize and identify issues pertaining to the working of accounts.
• Demonstrates the ability to handle varying tasks as well as understanding and interpreting procedures relative to the revenue process.
• Demonstrates knowledge of State and Federal regulations, HIPAA guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance.
• Recognizes situations, which necessitate supervision and guidance, seeks appropriate resources.
• Adheres to established departmental policies and procedures, objectives, process improvement initiatives, safety, environmental and infection control standards.
• Supports, models and adheres to the desired behaviors of the KBOS constitution and Covenant Health for integrity which are; hold others accountable for living the values and behaviors, protect confidential information, deal with difficult issues honestly, directly, respectfully and tell the truth.
• Demonstrates an ability to understand the payer requirements of insurance carriers
• Demonstrates an understanding of all patient information from the facilities and the specifics of each follow-up to ensure appropriate reimbursement is received.
• Professionally deals with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Performs specific functions relating to collection of patient accounts.
• Supports, models and adheres to the desired behaviors of the KBOS Constitution for quality which are; celebrate and reward successes, seek out better ways to do our job, set improvement goals and standards striving to meet or exceed them, participate in forming and being part of work teams when necessary and do not say "It's not my job".
• Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Consults and works collaboratively with Supervisors, Co-workers, Department Manager, and other facility personnel, effectively performing tasks of position.
• Attends meetings as required and participates on committees as directed.
• Promotes good public relations for the department and the facilities, adhering to desired behaviors.
• Assists Vice President, Director, Managers and Supervisors on activities and projects, as needed.
• Supports, models and adheres to the desired behaviors of the KBOS Constitution and Covenant Health for service which are; take ownership for our mistakes, resolve customer problems on the spot whenever possible, treat all people with respect and kindness, strive to meet or exceed customer expectations, collect and use customer feedback/data to improve processes and service and set an example for accountability and responsiveness: return e-mail and phone calls promptly, assure deadlines are met, keep commitments.
• Participates freely in intradepartmental quality improvement activities whenever called upon to do so.
• Provides assistance to new employees.
• Attends required In-Service training as scheduled.
• Supports, models and adheres to desired behaviors of the KBOS Constitution for caring which are; build a trusting environment by listening with an open mind and valuing different opinions; asking questions for understanding and allowing others to speak openly, do not gossip or criticize people behind their back, resolve conflicts, notice and express appreciation for good work and respect differences by listening with an open mind.
• The KBOS Constitution for developing people which are; commit time to learning and development, help others obtain the information and skills they need to succeed on the job and utilize training, education and development opportunities.
• Demonstrates promptness in reporting for and completing work, ensuring follow-through on assigned tasks.
• Demonstrates initiative in increasing skills and attends training programs as available
• Utilizes resources available appropriately, i.e. use of equipment and supplies.
• Supports, models and adheres to the desired behaviors of the KBOS Constitution for using the community’s resources wisely which are; be aware of cost and quality when making spending decisions, demonstrate a personal commitment to reduce waste, consider the impact on other departments and facilities within Covenant Health when making decisions or taking action and ensure that meetings lead to solutions.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Minimum Education:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED.  Preference may be given to individuals possessing a HS diploma or GED.

Minimum Experience:

One to Two (1-2) years’ experience in health care is preferred. Computer experience is required. Knowledge of medical terminology, claims submission, customer service is preferred.  Expected to perform adequately within the position after working at least three (3) to six (6) months on the job. Must be familiar with insurance plans and requirements and collection practices e.g. Fair Debt Credit and Collection Act.

Licensure Requirements:

None.