Account Specialist F/T Day

Responsible for processing insurance claims, coordinating collections, and managing delinquent unpaid accounts. Oversees claim processing, investigates billing problems, and assists with error resolution.

Responsibilities

• Assists in processing insurance claims, including Medicaid/Medicare claims.
• Collects and enters patient insurance information into the database.
• Assists patients in completing necessary forms and answers questions or concerns.
• Reviews and verifies insurance claims; requests refunds when appropriate.
• Processes Medicare correspondence, signatures, and insurance forms.
• Follows up with insurance companies to ensure claims are paid within outlined timeframes; resubmits unanswered claims.
• Answers telephones, screens calls, takes messages, and provides information.
• Maintains files with referral slips, Medicare authorizations, and insurance slips.
• Identifies delinquent accounts, aging periods, and payment sources.
• Processes delinquent unpaid accounts by contacting patients and third-party reimbursors.
• Reviews accounts, credit reports, and other information sources such as credit bureaus.
• Performs collection actions, including contacting patients by phone and resubmitting claims.
• Evaluates patient financial status and establishes budget payment plans; follows and reports status of delinquent accounts.
• Reviews accounts for possible assignment, makes recommendations to Credit Manager, and prepares information for collection agencies.
• Assigns uncollectible accounts to collection agencies or attorneys per clinic policy.
• Contacts lawyers involved in third-party litigation.
• Answers inquiries and correspondence from patients and insurance companies; develops collection letters.
• Identifies and resolves patient billing complaints; researches credit balances.
• Oversees claim processing and payments to third-party providers; answers associated correspondence.
• Monitors charges and verifies correct payment of claims and capitation deductions.
• Sends denial letters on claims and follows up on requests for information.
• Audits and reviews claim payment reports for accuracy and compliance; researches and resolves claim and capitation problems.
• Maintains timely provider information in physician files.
• Maintains insurance company manuals and distributes updates to staff.
• Maintains required databases, patient accounts, reports, and files.
• Resolves misdirected payments and returns incorrect payments to sender.
• Answers patient inquiries regarding account balances.
• Appeals denied claims adhering to payer policy and communicates with the department for further assistance.
• Works assigned claims within designated timeframes to ensure timely payment.
• Researches information needed to complete the billing process, including obtaining charge information from physicians.
• Works with staff to follow up on accounts until zero balance or turned over for collection.
• Assists with coding and error resolution.
• Maintains required billing records, reports, and files.
• Investigates billing problems and formulates solutions; verifies and maintains adjustment records.
• Maintains and enhances knowledge of assigned payers regarding billing guidelines.
• Provides training to front office staff on payer rules and guidelines for physician billing.
• Recommends changes to departmental processes to maximize operational effectiveness of the revenue cycle.
• Maintains strictest confidentiality.
• Participates in educational activities.
• Maintains a neat and professional appearance; demonstrates commitment to service and upholds office manual guidelines.
• Performs other duties as assigned.

Requirements

• High School diploma or equivalent OR post-high school diploma/highest degree earned.
• Associate degree in a technical specialty program of 18 months minimum in length preferred.
• Two (2) years of experience in billing, bookkeeping, collections, or customer service.

Skills

• Electronic Claims Billing experience.
• Experience in a multi-specialty group practice setting preferred.
• Intermediate ICD-9 and CPT coding abilities preferred.

Schedule

Day shift