Patient Account Specialist

Patient Account Specialist

The Patient Account Representative is responsible for the overall processing of all billed services, including claims submission, payment and remittance entry, research of unpaid or denied claims and aged accounts receivable follow up.

Essential Job Functions and Responsibilities

• Completes daily data entry of all incoming accounts receivable payments including personal payments, insurance payments, interest, medical records fees, and miscellaneous deposits.
• Posts electronic remittance advice (ERA) or explanation of benefits (EOB) to reflect accurate insurance payments, contractual adjustments, denials and recoupments.
• Performs daily electronic transmission of claims and patient statements. Verifies successful claims submission by reviewing clearinghouse reports for acceptance and/or rejection.
• Prints and mails paper claims with appropriate documentation.
• Researches all claim denials, provider level balances (PLB), offsets, recoupments, and incorrect payments or adjustments.
• Prepares patient or insurance refund paperwork for processing of credit balances within 60 days of discovery.
• Maintains daily cash flow chart, balances daily posting and insurance checks, and runs adding machine tape for deposit and prepares daily deposit for the bank.
• Researches monthly aged account receivable lists to assure that accounts receivable levels are within organization targets.
• Receives billing calls, answers questions, and assists patients with issues they may have regarding their accounts, and receives collection calls on delinquent accounts and arranges payment plans, or refers to financial counselor, if appropriate.
• Contacts insurance companies and other agencies regarding patient issues, benefits, or claim concerns.
• Maintains up-to-date knowledge of rules and regulations for medical billing. Maintains detailed and thorough knowledge of payer-specific laws and requirements to submit claims in a legal and compliant manner.
• Performs other duties as assigned.

Minimum Qualifications

• Education
  • High school diploma or equivalent required.
• Licensure/Certification
  • Advanced training/certification in medical billing, coding, and/or insurance preferred.
• Experience
  • Minimum of one-year experience in a medical billing role is required, or equivalent education.

Competencies Required

• Knowledge
  • Working knowledge of medical and insurance terminology.
  • Basic knowledge of CPT, HCPCS, and ICD-10 coding.
• Skills
  • Possesses interpersonal, communication, and listening skills necessary to deal effectively and courteously with patients and all staff members.
  • Proficient computer skills working in an Electronic Medical Record (EMR) and Practice Management software, and Microsoft Word, Excel, and the Internet.
  • Demonstrates professionalism and respect in all forms of communication and correspondence.
  • High level of accuracy and efficiency when entering patient financial and related data.
• Abilities
  • Ability to maintain strict confidentiality of fiscal and health information.
  • Ability to work in a fast paced, multi-tasking environment and cope with rapidly changing demands while working as a team member.
  • Ability to prepare and gather information accurately and efficiently.