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Occupational Account Representative

The Occupational Account Representative (OAR) will be responsible for submission of accurate and prompt first and second billing of assigned occupational accounts and timely collections of past due account balances from employers and third party payors. The OAR also provides clerical and administrative support relating to occupational issues to employers, other third party payors, patients, clinics and administrative personnel. Based on business requirements, the OAR will be expected to occasionally perform other duties within the billing office as assigned by Occupational Billing Manager (OBM).

Work Hours:

The normal work-week is 35-40 hours/week full-time, Monday through Friday as scheduled.  Occasional overtime or variations (including evenings and Saturdays) may be required or authorized.

Education & Training:

  • Must have High School diploma or GED
  • Must have one of the following:
    • 2 years related experience
    • Certificate in related field plus 1 year related work experience

Essential Knowledge, Skills & Abilities:

  • Must possess good customer service skills
  • Must be organized, detail oriented and able to adapt quickly to stressful work environment
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)
  • Ability to communicate in Spanish helpful
  • Must possess effective reasoning and deductive ability
  • Must be able to read, correctly interpret and follow written guidelines/protocols
  • Must maintain confidentiality when dealing with medical information
  • Must be able to learn and apply new skills
  • Experience using a 10-key adding machine preferred
  • Basic knowledge of billing, invoicing, and payment posting required
  • Basic knowledge of CPT and ICD-9 codes preferred
  • Knowledge of medical terminology, its spelling and abbreviations preferred
  • Billing software experience required, current TMC medical software experience preferred
  • Good computer and keyboarding skills: Microsoft Word required; Excel and Outlook preferred
  • Medical transcription experience helpful

Essential Job Functions & Duties:

  1. Prepares bills for mailing (copying, stapling, folding and stuffing)
  2. Pulls, photocopies, and organizes records (charts, Explanation of Benefits (EOBs, receivables, etc.) as needed
  3. Organizes and faxes materials
  4. Answers phones as needed
  5. Sorts and distributes run box as assigned
  1. Reviews and edits occupational charts
    1. Verifies each patient is on correct account and charged correct fees
    2. Calls employers or reviews chart notes for information needed to set up new employer accounts
    3. Adds any special information required by specific employers
    4. Moves patients from Temporary Employer to correct employer
    5. Corrects case information
    6. Corrects checkout for any changes in charges
  2. Splits occupational billing from work injury charts previously billed to work comp insurance carriers
    1. Creates case for occupational fees
    2. Deletes charges from original work comp chart
    3. Adds charges to new occupational chart
    4. Attaches to correct case
    5. Corrects fees
    6. Corrects Checkout
    7. Prints and mails separate invoice for split, if needed
  3. Prints first and second bills based on schedule
    1. Runs outstanding insurance report for occupational insurance and reviews for accuracy
    2. Makes any necessary corrections
    3. Prints bills
    4. Reviews bills for accuracy
    5. Copies bills and files for use in posting
    6. Folds and stuffs bills for mailing
    7. If bill is still outstanding after 60 days, uses second billing process to rebill employer
  4. Reviews correspondence received and partial payments
    1. Reviews activity on account
    2. Contacts employer or researches TMC documents to clarify information
    3. Corrects case attached to patient
    4. Adds new information or corrects existing information on all dates of service (DOS) relating to case
    5. Requests any documentation required by employer and payor
    6. Prints statement if needed
    7. Documents actions
  5. Monthly – prints Employer Detail report for all outstanding balances >45 Days (Occupational)
    1. Reviews each employer to be sure billing and payment information is correct
    2. Makes any necessary changes or corrections to account and case
    3. Contacts employer regarding payment status or rebill account
    4. Processes and sends Pending COD and Confirmation of COD letters
    5. Documents actions
  6. Information maintenance
    1. Researches Occupational credit balances and Occupational payments posted to Miscellaneous accounts
    2. When notified by employer, or when mail is returned, researches available documentation to determine correct billing, corrects information and rebills charges
    3. Notifies Business Development and Marketing (BDM) and OBM when employer information needs to be changed or added
  1. Interacts with staff members professionally
  2. Follows company policies and procedures (time and attendance, appropriate attire, etc)
  3. Correctly uses office equipment and time clock
  4. Works safely
  5. Other duties as assigned
  6. Must be punctual and reliable in attendance

Customer Service Skills:

  1. Answer occupational phones
  2. Answer questions from internal and external customers in a professional manner
  3. Respond to requests from internal and external customers in a professional manner
  4. Meets the service expectations of patients
  5. Resolves problems identified by patients
  6. Meets the service expectations of internal customers
  7. Resolves problems identified by internal customers
  8. Meets the service expectations by external customers
  9. Resolves problems identified by external customers
  10. Follows through on commitments
  11. Interacts with co-workers in other departments in a manner that promotes teamwork and facilitates company goals

Working Conditions & Risks:

Work is indoors in a well lighted, and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk). Potential risk exists from accidents while using routine office equipment.

Physical Requirements:

Position requires occasional need to lift heavy (30-50lbs) boxes from chest height to floor to chest height. Prolong sitting, sorting, moving about, and intermittent typing approximately 4-6 hours per day routinely. Good vision, good hearing, and clear speech required (correctable). Repetitive motions consist of extended periods of upper body and upper limb movements (arms, hands, and wrists). Prolong use of phone and computer.

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