Patient Accounts Resolution Specialist Patient Accounts General Hospital

Job Summary

Review unpaid and underpaid claims to ensure that claims are paid accurately and timely according to company policies payer contracts and governmental regulations. Perform follow up on unpaid or underpaid claims to ensure that claims are completely resolved accurately and timely and efforts are thoroughly documented.

Responsibilities

Review assigned work items daily to resolve at risk past due and technical denial claim issuesWork with coding to resolve coding related denialsWork with Utilization Review to resolve authorization related denials and appealsUse various payer web portals and DDE systems to obtain claim information that will help in resolution Contact payers by phone to resolve claim issuesContact Physician offices to obtain necessary information needed to resolve claimsManually and accurately resolve claims in Suspense (Medicare only)Ensure that medical records and itemized statement are submitted and received when requested by payers (work with contracted agencies as applicable)Follow proper workflow assigned by managementEnsure accurate rebilling of claims to avoid denialsCommunicate billing errors that can be prevented to Department Manager Supervisor or Team LeadCommunicate identified system related issue to Department Manager Supervisor or Team LeadAccurately Professionally and thoroughly document necessary information necessary to resolve outstanding balances in encounter timelineEnsure that result driven follow up is be accomplished and documented. Other duties as assignedSkills:Healthcare billing and collection knowledgeAbility to interpret a payer explanation of benefit (EOB)Ability to identify and resolve claim issuesExcellent communication and customers service skillsComputer and keyboarding skillsKnowledge of Microsoft software applications (Excel and Word) a plusCerner knowledge a plus

Knowledge Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment treatment or care as defined by the departments identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the StatementMust demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency Duties and Responsibilities(Essential duties common to all positions)1. Maintain and document all applicable required education.2. Demonstrate positive customer service and co-worker relations.3. Comply with the companys attendance policy.4. Participate in the continuous quality improvement activities of the department and institution.5. Perform work in a cost effective manner.6. Perform work in accordance with all departmental pay practices and scheduling policies including but not limited to overtime various shift work and on-call situations.7. Perform work in alignment with the overall mission and strategic plan of the organization.8. Follow organizational and departmental policies and procedures as applicable.9. Perform related duties as assigned.

Education

High School Diploma or GED (Required) Experience: 1-2 years collections customer service or other comparable experience. Medical Terminology background and 5-7 years related experience preferred.

Credentials

Work Schedule: Days

Status: Full Time Regular 1.0

Location: General Hospital

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Lisa J. Craft

Required Experience:

IC