Patient Account Specialist - Revenue Cycle PB Billing & Denials (19.99hr/wk)

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.

Required Education / Experience

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

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, research 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 / 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.

Salary Range

Actual salary commensurate with experience.

Work Schedule

Monday through Friday, 8am to 5pm and as needed on occasion.