Patient Account Specialist III - Santa Ana, CA

Job Description

Job Description

SUMMARY

Performs third party billing and collection of accounts for non-governmental third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental third-party payers. Duties include billing, collections, refunds, adjustments, EOB review, appeals, and denials. Acts as a lead in the department by assisting newly hired team members with answers to questions and stands in for supervisor in supervisor’s absence. Works on special complex high priority projects as assigned by management.

REQUIREMENTS

RESPONSIBILITIES AND DUTIES:

• Responsible for ensuring timely submission of non-governmental claims in the billing editor. On a daily basis prepares and submits primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management. Able to prepare and submit complex claims including split bills, interim bills, benefits exhaustion, etc.
• Monitors billing editor for correct claim edits and reports findings to management for approval to make edit corrections. Submits bridge routines to billing vendor as necessary and approved by CBO management.
• Shows proficiency in the ability to reconcile complex accounts, i.e. split payments, interim claims, benefits exhaustion, sequestration calculation, etc. Prepares and submit appeals as appropriate.
• Performs account analysis, calculates and posts adjustments and write-off transactions to patient accounts receivable as appropriate with management approval.
• Ensures all charge and coding related issues are clearly identified and entered in the HIM/Charge audit spreadsheet for clarification and resolution. Follows up to ensure timely response from others and ultimate resolutions.
• Assists management with completing special AR projects as needed. Demonstrates the ability to complete the project with minimal management intervention. Partners with CBO management to prepare payer packets/spreadsheets of outstanding claims for meetings between CBO and payer representatives.
• Provides training and education to CBO team members as requested by management. Acts as a Lead in the department by assisting newly hired team members with answers to questions and also assisting management as requested.
• Identifies payer trends and reports to management providing input on appropriate steps to take. Provides account-level support as needed to AR vendors.
• Maintains productivity levels within guidelines established by management. Receives an at or above team average productivity score
• Documentation. Documents clearly and succinctly in account notes all action taken on account, i.e., phone call numbers, representatives spoken to, corrective action taken, referrals made and specific claim submission details as appropriate.
• Performs duties with little or no errors. Remains at or above team average quality of work errors.
• Other duties as assigned.