Patient Account Specialist - RCO HB Follow Up (Hybrid Remote)

Educations & Experience

• Minimum Qualifications: Two years of financial experience or one year of patient accounts experience.
• Preferred Qualifications: 1+ year of experience in Medical Billing and/or Revenue Cycle Operations (working knowledge of claims processing, EOBs/remittance, cash posting, eligibility verification, patient registration, and/or medical coding).
• 1+ year of experience working with various insurance payers, including navigating payer portals to obtain claim status, access provider manuals, and interpret reimbursement policies and methodologies.
• 1+ year of experience utilizing work queues and documenting account notes within a healthcare billing or patient accounting system.
• 1+ year of experience applying analytical and problem-solving skills, including the ability to critically evaluate data, identify root causes, and recognize trends.

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. Takes necessary actions to ensure timely and appropriate reimbursement and account resolution.

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.
• Assists 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.
• Assists 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

Monday - Friday, availability required between 6:00 AM – 6:00 PM. Hybrid schedule: initial training period conducted onsite (up to 4 weeks); following training, onsite presence required a minimum of 1 day per month.