Patient Account Representative – Cost Estimates, Insurance Verification, and Pricing Analyst

Position Summary

  • The Patient Account Representative for Patient Cost Estimates, Insurance Verification, and Pricing Analysis is primarily responsible for identifying uninsured patients, preparing cost estimates in advance of the services they are schedule to received and sharing the estimates with the affected patients in accordance with the requirements of the Federal No Surprise Billing statutes.
  • In addition to the patient cost estimate duties, the incumbent will be responsible for the performing insurance verification activities and keep the hospital chargemaster file current, update the data housed in the Craneware software program, and routinely analyze peer hospital pricing in the marketplace to ensure that KHC’s charges are reasonable.

Essential Functions

  • Runs reports to generate lists and works with other internal hospital parties to identify potential patients who are uninsured, then conducts research using a variety of tools to confirm whether the patient in fact has insurance or not.
  • If research suggests the patient does have insurance, the incumbent will be responsible to contact the patient to confirm current insurance information and ensure the system is updated to include the insurance payer for proper billing.
  • Upon confirmation that the patient does not have health insurance, the incumbent will be responsible for preparing and delivering cost estimates in advance to the affected patients.
  • The incumbent may also serve as a back-up to the hospital’s Financial Counselor when needed to research and resolve patient questions related to their bills as needed.
  • Performs patient insurance verifications for assigned insurance payers to ensure claims are filed appropriately for payment.
  • Ensures that the chargemaster file housed within the electronic medical records system (Cerner) is kept current. This includes but is not limited to; adding new CPT/HCPCS codes and deleting retired/replaced codes upon implementation by the payers along with, periodically reaching out to the various ancillary department heads to delete codes that are no longer active, then placing an end date in the Cerner pricing tool. Also, partners with the person assigned to set and maintain hospital prices, as needed.
  • Undertakes the necessary action to ensure that all the data contained in the chargemaster file housed within the electronic medical records system (Cerner) agrees with the relevant data contained in the Craneware software program used routinely by the medical coders, business office staff and others. Since there is not a computerized interface between the two platforms, this is currently a manual process.
  • Keep the Craneware program current by following the procedures outlined in the maintenance portion of the system requirements.
  • Conducts routine pricing analyses (monthly or quarterly at a minimum) of hospital charges on two levels, first, other local area hospitals within a reasonable proximity to Knoxville, Iowa and, regional Mercy affiliates in central Iowa with the compiled data being shared with KHC’s CFO.
  • Performs other duties as assigned by the Department Head based on the priorities and needs of the business, as applicable.
  • Maintains professional and technical knowledge by attending educational workshops reviewing applicable professional publications.

This is a Full-Time position and includes benefits such as Medical, Dental, Vision, STD/LTD, Retirment Plan, and accrued Vacation.

*COVID 19 Vaccine required or qualified exemption