Account Specialist, FT, Days

Insurance Claims Processor

Inspire health. Serve with compassion. Be the difference.

Responsible for processing insurance claims. Coordinates collections and delinquent unpaid accounts. Oversees claim processing. Investigates billing problems and assists with error resolution.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Assists in the processing of insurance claims including Medicaid/Medicare claims.
• Collects and enters patient's insurance information into database.
• Assists patients in completing all necessary forms. Answers patient questions and concerns.
• Reviews and verifies insurance claims. Requests refunds when appropriate.
• Processes Medicare correspondence, signature, and insurance forms.
• Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures.
• Resubmits insurance claims that have received no response.
• Answers telephone, screens call, takes messages, and provides information.
• Maintains files with referral slips, Medicare authorizations, and insurance slips.
• Identifies delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contacting patients and third party reimbursors.
• Reviews each account, credit reports and other information sources such as credit bureaus via computer.
• Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors.
• Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
• Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.
• Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy. Contacts lawyers involved in third-party litigation.
• Answers inquiries and correspondence from patients and insurance companies. Develops collection letters.
• Identifies and resolves patient billing complaints. Research credit balances.
• Oversees claim processing and payments to third party providers. Answers associated correspondence.
• Monitors charges and verifies correct payment of claims and capitation deductions.
• Sends denial letters on claims and follow-up on requests for information.
• Audits and reviews claim payments reports for accuracy and compliance.
• Research and resolves claim and capitation problems.
• Maintains timely provider information in physician files.
• Maintains insurance company manual and distributes information to staff on updates and changes.
• Maintains required databases and patients accounts, reports and files.
• Resolves misdirected payments and returns incorrect payments to sender.
• Answers patients' inquiries regarding account balances.
• Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.
• Works all assigned claims within designated time frame to ensure timely and appropriate payment
• Research all information needed to complete billing process including getting charge information from physicians.
• Works with other staff to follow-up on accounts until zero balance or turned over for collection.
• Assists with coding and error resolution.
• Maintains required billing records, reports, and files.
• Investigates billing problems and formulates solutions. Verifies and maintains adjustment records.
• Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing
• Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.
• Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.
• Maintains strictest confidentiality.
• Participates in educational activities.
• As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.
• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma / highest degree earned. Associate degree in a technical specialty program of 18 months minimum in length preferred
• Experience - Two (2) years in billing, bookkeeping, collections or customer service.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Electronic Claims Billing experience
• Multi-specialty group practice setting experience preferred
• Intermediate ICD-9 and CPT coding abilities preferred

Work Shift: Day (United States of America)

Location: Patewood Outpt Ctr/Med Offices

Facility: 1008 Greenville Memorial Hospital

Department: 10267158 Peds Ophthalmology

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.