Patient Account Specialist - Revenue Cycle HB Billing & Denials

REQUIRED EDUCATION:

High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience.

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 insure 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-10, 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

•      Appeal 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 JOB 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

•      Performs related duties as required.

PREFERRED SKILLS:

Some knowledge of physician denials and appeals experience preferred

Some knowledge of patient billing, or collection/reimbursement procedures in a healthcare setting preferred

Experience working with insurance payors preferred

Revenue Cycle background preferred

SALARY RANGE:

Actual salary commensurate with experience.