Patient Accounts Specialist

Job Title

Understands Medicare, Medicaid, Managed Care, and Commercial insurance fundamentals.

Understands federal and state regulatory requirements and compliance standards.

Working knowledge of coding / reimbursement methodologies, including MS-DRG / APC, APR-DRG / APG, and fee schedules.

Resolves billing edits timely and works / reviews billing work queues and/or reports to ensure claims are released and accepted by payers within the contracted timeframe.

Performs diligent account follow-up, resolving A/R balances timely and effectively. Follow-up functions include but are not limited to: payer portal claim status checks, calling payer, submitting requested documentation (e.g., Medical Records) appealing denied claims, making outbound patient calls, updating insurance and generating claim rebills, adjusting receivable balances to the appropriate adjustment code & within departmental staff threshold, etc.

Performs accurate payment reviews.

Works credit balances and follows departmental payer and patient refund procedures.

Posts hospital remittances electronically and/or manually in the Allscripts system.

Assists patients with hospital bills, inquiries, etc.

Responds to payer / regulatory audit requests timely (e.g., Cotiviti, OMIG, IPRO).

Manages / works correspondence in a timely fashion. Ensures correspondence is scanned into the Allscripts system as appropriate.

Documents actions in Allscripts and other appropriate systems. Adheres to departmental documentation standards.

Familiar with Allscripts electronic billing system, Change Healthcare scrubber / clearinghouse, payer portals, Revenue Cycle Workflow application (TRAC), and audit tracking system.

Ability to work in multiple system applications and highly comfortable with using a computer.

Proactively escalates payer, patient, reimbursement, compliance, regulatory, workflow, and technology issues to Management.

Collaborates and effectively communicates with external departments. Processes external department requests timely (e.g., UB-04).

Engages in departmental meetings and training opportunities.

Meets departmental quality and productivity standards.

Works special projects as assigned.

Completes other duties as assigned.

Position Requirements

This position requires a minimum formal education of High School Diploma or equivalent and a minimum of 3 years job-related experience.

Desired (not required) criteria include: 3+ years of medical hospital billing experience.

Experienced in Government and Commercial hospital billing guidelines and regulations. Must be able to research multiple issues and effectively communicate outcome while meeting internal quality and productivity guidelines.