Account Specialist / Certified Professional Coder - Practice Advantage

Responsible for managing and performing efficient and effective Accounts Receivable functions for physician clients with consistently high productivity as measured by the transaction volume and quality of work performed.

• Charge Posting
• Accurately post all claims within 2 days of receipt from physician’s office.
• Insurance Claim Management
• Files claims within 2 days from receipt of charges. Submits claims on a daily basis – on accounts where charges are received daily.
• Verify audit trail reports from electronic claim filing within 48 hours
• Institutes corrective action of audit trail exceptions prior to verification
• Provides follow-up and corrective action on all claims over 45 days old routinely once per month
• Maintains files, records in organized orderly manner.
• Patient Account Management
• Transfers accurate balance from insurance account to patient account at time of insurance payment postings or upon receipt of appropriate denials.
• Manages patient balances in accordance with practice policy and physician instruction.
• Provides monthly review and recommendations to physician(s) regarding delinquent patient balances and noteworthy patient contact.
• Routinely performs insignificant balance write-offs once per month per physician policy.
• Communication and Coordination with Physician Office Staff
• Communicates with physician(s) office staff weekly (or more often as needed) regarding
  
  
  

insurance denials, rejections resulting from errors in patient masterfile/insurance policy information.

• Performs monthly review with physician(s) regarding charges, payor mix, office collections, A/R aging, changes in reimbursement policy, payments by insurance class, producer, general recommendations.
• Assists with the training process of new and existing physician office staff.
• Travels to physician’s practice as deemed necessary to communicate/educate on any issues pertinent to the practice management functions.
• Works routinely toward maximizing efficiency and cost effectiveness of activities
• Recommends action or payment plans on patient accounts over 45 days old with no payment history, also in conjunction with the collection process.
• Develops cooperative relations with office staff to effect accurate patient information.
• Recommends policy, procedures, and ideas to improve Practice Advantage performance.
• Volunteer’s assistance support to co-workers as need indicates.
• Maintains up-to-date manual of billing procedure practices unique to account including write off policies and procedures
• Assists in the continued education/training process of the Account Specialist I Staff & II Staff
• Performs adequate charge master reviews at least annually and more often as deemed necessary and upgrades charges appropriately in accordance with physician(s).
• Assists other Account Specialist I & II Staff in the performance of adequate charge master reviews at least annually and more often as deemed necessary and also assist in the upgrading of charges appropriately in accordance with physician(s).
• Assists Account Specialist I & II Staff in all day to day Accounts Receivable activities/functions. Provides coding oversite and review on charge sheets and superbills as charges are submitted for posting. Assist Account Specialist as necessary in evaluating codes submitted from client practices and makes recommendations to be presented to physician as appropriate.
• Coding Certification & Maintenance
• Coding Certification from National Accreditation such as AHIMA or AAPC.
• Maintains coding certification at this level.
• Assists in coding audits as audits are contracted with physician practices.
• Enhances business and financial management functions of client’s practice
• Assists in the Business/financial functions of the Accounts Receivable processes for client(s) by providing adequate feedback, accounts receivable reporting and by also assisting in the maintenance of changes affecting the accounts receivable processes for the individual client and the Practice itself (taking a hands-on role) providing adequate and accurate reporting mechanisms to cut costs – maximize reimbursement – provide significant training and feedback to staff and physician) Maintains this hands-on role on a consistent basis.
• Analyzes and Monitors cost/reimbursement relationship for relevant procedures, medications & supplies for physician practices.
• Acts as liaison with Medicare & BCBS regarding medical necessity criteria and precertification issues
• Establishes audit controls for lost charges and knows how and when to put these controls into place.
• Assists in coding audits as audits are contracted with physician practices.
  
  
  

DCH Standards

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.
  
  
  

High School Graduate or higher. Must be certified by National Accreditation such as AHIMA or AAPC. Detailed knowledge and experience of health provider insurance claims software processing for a private/professional medical practice setting. Prior experience do physician/provider professional fee billing is preferred. Detailed knowledge and experience of insurance coverage processes. Experience with computer billing/collection systems and past experience filing insurance required. Detailed knowledge and experience of all coding/billing/insurance/processes including detailed coding knowledge and experience consisting of at least ICD10 CM, CPT, HCPS, utilization of modifiers, bundling edits, etc for part B, HCFA 1500 claim filing.

Holds active coding certification from National Accreditation for physician practice setting.

Demonstrated ability to work well with public physicians and staff in a mature responsible self-confident manner. Very good interpersonal/communication skills, customer service skills and history of good attendance required. Must be able to read, write legibly, speak, and comprehend English.

WORKING CONDITIONS

Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.

Valid driver’s license and automobile liability insurance. Very good interpersonal communication and customer service skills required.

Physical Medium work – Exerting 20 – 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects. Physical Demand requirements are in excess of those for Light Work. Good manual and finger dexterity. Ability to tolerate prolonged periods of sitting. Some light driving required.

Psychological Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.