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This is a Stanford Health Care job.

A Brief Overview
The Patient Account Representative (PAR) is responsible for the timely and accurate processing of insurance balance patient claims in accordance with contracts and policies. The PAR works in various capacities to support the primary goal of the business office to resolve of unpaid, underpaid, denied or unresolved patient accounts.

Depending on the specific team, the PAR's focus may be on a mix of various responsibilities from across the Patient Financial Services (PFS) operations. Responsibilities may include:

- Accounts receivable collections and payer follow-up

- Payer denial review and appeals processing

- Payment posting and batch reconciliation

- Credit balance review and resolution

- Retroactive eligibility and registration

- Underpayment reconciliation

- Client or other special billing

A PAR IV works primarily in Epic, to perform the full range of duties for this assigned class. The PAR IV position is an expert-level position with a proven track record in hospital patient accounting, and an extensive knowledge of reimbursement requirements of all types of healthcare payers. A PAR IV will act as a key resource for the team management in problem-solving difficult issues, analyzing complex accounts, and assisting with training needs.

Locations
Stanford Health Care

What you will do

• Working a wide range of denial types from various payers, applying critical thinking to the follow-up process, researching payer policies, and reviewing billing errors

• Resolving claim edits

• Electronic or hardcopy claims editing and submission to payers

• Reconciling payment posting files in Epic, as well as related adjustments

• Identifying trends and root cause analysis for various payer, denial, cash posting, credit or other patterns to resolve; identify potential prevention steps

• Reviewing and analyzing payer variances, pursuing underpayments with payers as necessary

• Aiding in the Epic configuration of payer contract models

• Reviewing and resolving payer rejections, denials, and performing customized appeals

• Resolving credit balances

• Completing all types of charge corrections

• Completing special projects as assigned by management as needed

Education Qualifications

• High School diploma or GED equivalent

Experience Qualifications

• Six (6) years of progressively responsible and directly-related work experience

Required Knowledge, Skills and Abilities

• Meets weekly individual productivity goals and standards while following planned priorities as set by the Team Manager

• Can maintain professional communication with various PFS staff, payers, and patients regarding the billing of services.

• Ability to follow oral and written instructions and interpret institutional and other policies accurately

• Ability to communicate clearly and professionally both verbally and in writing

• Ability to maintain confidentiality of sensitive information

• Ability to perform basic data analysis

• Proficient in Excel, including creating, organizing, and performing basic PivotTables

• Ability to plan, prioritize, and meet deadlines

• Ability to work effectively with individuals at all levels of the organization

• Knowledge of accounts receivable software systems and medical billing operations

• Familiarity with medical reimbursement policies and procedures and medical terminology

• Knowledge of payer landscape, including Medicare, Medicaid, Workers’ Compensation, Managed Care, or other Commercial insurance

Licenses and Certifications

• None

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.