Covenant Health

Patient Account Representative-Insurance Claim Follow Up

Full-Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 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, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. 

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.  The Patient Account Representative (PAR) Level II position serves as a resource to PAR Level I staff by providing training and assistance in solving complex issues.  A Level II has the ability to handle and resolve complex issues with little or no supervision resulting in the correct outcome.

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-368-7313

• Assists Collection 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.
• 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.
• Consults and works collaboratively with Supervisors, Co-Workers, Department management, and other facility personnel, effectively performing tasks of position.
• Attends meetings as required and participates on committees as directed.
• Perform other duties as assigned or requested.
• Promotes good public relations for the department ad the facilities, adhering to desired behaviors.
• Participates freely in intradepartmental quality improvement activities whenever called upon to do so.
• 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.