Patient Account Specialist - RCO HB Follow Up

Education & Experience

• Minimum Qualifications: Two years of financial experience or one year of patient accounts experience.
• PREFERRED QUALIFICATIONS:
  • Role-Specific Experience: 1-3+ years of experience in healthcare billing, revenue cycle, or medical collections.
  • Payer Knowledge: Strong understanding of Medicare, Medicaid, and major commercial insurance claim filing guidelines.
  • Payer Portals: Experience utilizing insurance web portals to verify claim status, access provider manuals, and review reimbursement methodologies.

  JOB SUMMARY

  The Patient Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims.

  ESSENTIAL JOB FUNCTIONS

  • Demonstrates a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines.
  • Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements.
  • Billing payers and/or clients for hospital and/or Professional Patient Accounts.
  • Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims.
  • Performs online corrections to edited claims according to procedures.
  • Performs detailed follow-up activities on assigned accounts according to procedures.
  • Responds to daily correspondence according to procedures.
  • Identifies denials and underpayments for appeal.
  • Reviews, researches, and processes denied claims.
  • Appeals claims as appropriate according to policies and procedures.
  • Updates account information and documents as appropriate within Epic Resolute.
  • Processes account adjustments according to policies/procedures.
  • Issues payer and/or patient refunds according to policies/procedures.
  • Validates accuracy of payments and/or adjustments on accounts.
  • Resolves outstanding accounts at required accuracy and productivity requirements.
  • Maintains comprehensive knowledge of the work unit assigned.
  • Affords assistance in the development of department policies and procedures.
  • Adheres to established policies and procedures.
  • Adheres to internal controls and reporting structure.
  • Maintains open and professional communication with customers, colleagues, and vendors.
  • Performs well in a team environment.

  Marginal or Periodic Functions

  • Successfully completes competency-based training and testing.
  • Prioritizes and completes all work in an accurate, effective, and efficient manner.
  • Participates in team meetings/activities and supports the philosophy and goals of the team and department.
  • Affords assistance in the training and mentoring of new employees.
  • Reads all announcements and relevant communications relating to job duties.

  WORKING ENVIRONMENT/EQUIPMENT

  Standard hospital, clinical, laboratory and/or office environments. Standard office equipment.

  SALARY RANGE

  Actual salary commensurate with experience.

  WORK SCHEDULE

  On-site, Monday through Friday, 8 AM - 5 PM.