PMC Accounts Receivable Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Demonstrates knowledge and ability to follow medical billing practices.
• Demonstrates knowledge of Level I Healthcare Common Procedure Coding Systems (HCPCS) comprised of Current Procedural Terminology (CPT-4) and International Classification of Diseases (ICD) codes.
• Demonstrates knowledge of Medicare, Medicaid, Insurance Managed Care Plans and Workmen’s Compensation.
• Manages Accounts Receivable effectively, reviewing with manager problem claims.
• Reads and monitors bulletins from plans subscribed to for changes and updates in claims submission.
• Follow up phone calls on collections.
• Gives professional customer service to patients and public at all times.
• Maintains any logs necessary for collections and QA purposes.
• Downloads Medicare receipts on accounts.
• SUBMIT CLAIMS TO MEDICARE, MEDICAID, PRIMARY INSURANCES, AND SUPPLEMENTAL/SECONDARY INSURANCES.
• Enter charges for services rendered.
• Re-submits claims as necessary and handles appeals process when necessary.
• Researches and resolves correspondence from insurance carriers or private patients concerning claims.
• Reviews and corrects claim edits and denials to ensure proper payment for services rendered.
• Develops and maintains positive, effective working relationships with other employees, supervisors and medical providers.
• Ensures strict confidentiality of financial and medical records under HIPAA, HIPAA Security laws and hospital/clinic policies and procedures.
• Communicates clearly written and oral medical information to professional practitioners and/or the general public.
• Attends meetings as required.
• Miscellaneous duties as assigned requested or required.

QUALIFICATIONS

• Communicates in an effective manner, follows written or verbal instructions and demonstrates good interpersonal skills to deal with team members, patients and families.
• Knowledge of insurance policies.
• Competent with the accounts receivable accounting system.
• Competent in Microsoft Office Word and Excel.
• Maintain discretion and confidentiality in communications.
• Familiar with policies and procedures regarding reporting and release of protected health information (PHI).

EDUCATION AND/OR EXPERIENCE

• High School Diploma/GED
• 1 year experience in bookkeeping, clerical and applicable computer training
• Prior physician office or medical coding, preferred
• MediTech Experience, preferred

LANGUAGE/READING SKILLS

• Communicate verbally and in writing in English.

MATHEMATICAL SKILLS

• Must be proficient at mathematical and statistical calculations.

REASONING ABILITY

• Employee responds to unusual or varied situations that are not covered by existing standards, procedures and precedents.

WORK ENVIRONMENT

• Employee is regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms.
• Employee must frequently be able to lift 25 pounds from the floor to waist level.
• Specific vision abilities include close vision and the ability to clearly focus vision.