Department Overview:
As the Medicare Follow-up Rep (Patient Account Rep) is responsible to follow-up, process adjustments, collect on accounts, and/or perform customer service duties to ensure that monies due to OHSU Hospitals & Clinics are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on the payer mix, patient flow and workload fluctuations. Serves as a Medicare RAC audit liaison between the Office of Integrity and PBS.
Function/Duties of Position:
OHSU is Oregon’s only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health – and with a network of campuses and partners throughout Oregon. We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland’s largest employer. And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.
As the Medicare Follow-up Rep (Patient Account Rep) is responsible to follow-up, process adjustments, collect on accounts, and/or perform customer service duties to ensure that monies due to OHSU Hospitals & Clinics are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on the payer mix, patient flow and workload fluctuations. Serves as a Medicare RAC audit liaison between the Office of Integrity and PBS.
Third-Party Follow-Up and Collection
- Analyze and follow-up on Medicare accounts on AEOS worklist and take appropriate action(s) to resolve all account balances. STANDARD: 250 action items (average, depends on staffing)
- Supply needed information to Medicare that will expedite processing of payments, i.e., resubmit claims, correct Return to Provider claims, prepare appeals, communicate with various third parties and our patients.
- Process financial allowances, contract allowances and other adjustments as appropriate.
- Access various systems to check claim status and eligibility. Systems may be online or require phone contact. Responsible for maintaining a high level of security and confidentiality in the use of these systems.
- Update account insurance coverage as appropriate.
- Calculate outpatient MSP claim reimbursement and determine if billing is necessary.
Customer Service
- Receive phone calls from Customer Service and other Patient Business Services sections. Analyze account activity to provide explanations and resolve customer concerns. Update account information as needed.
- Review inappropriate charges, determine which accounts should be escalated to supervisor’s attention, and take necessary steps to resolve customer concerns.
Other Duties as Applied
Required Qualifications:
- Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office; OR
- Four years of general collection, billing or customer service experience; OR
- Equivalent combination of education and experience.
- Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.
- Recent Microsoft Office applications experience in Windows environment (within the last 2 years)
- Recent online payer experience (within the last 3 years)
- Current Medicare program knowledge (within the last 3 years)
Job Related Knowledge, Skills and Abilities (Competencies):
- Familiarity with medical terminology
- Typing 55 WPM
- Ability to use multiple system applications
- Strong written and oral communication
- Legible handwriting
- Detail oriented, analytical
- Ability to interpret regulations
- Punctual, good attendance, positive attitude
- Ability to work in high volume, production environment
- Excellent customer service skills
- Knowledge of CPT, HCPCS, ICD-10 coding
- Strong self-directed work ethic and ability to exercise independent judgement