Overview
Responsible for managing and performing efficient and effective Accounts Receivable functions for physician clients with consistently high productivity as measured by the transaction volume and quality of work performed.
Responsibilities
Charge Posting:
Accurately post all claims within 2 days of receipt from physician’s office.
Insurance Claim Management:
Files claims within 2 days from receipt of charges. Submits claims on a daily basis – on accounts where charges are received daily.
Verify audit trail reports from electronic claim filing within 48 hours
Institutes corrective action of audit trail exceptions prior to verification
Provides follow-up and corrective action on all claims over 45 days old routinely once per month
Maintains files, records in organized orderly manner.
Patient Account Management:
Transfers accurate balance from insurance account to patient account at time of insurance payment postings or upon receipt of appropriate denials.
Manages patient balances in accordance with practice policy and physician instruction.
Provides monthly review and recommendations to physician(s) regarding delinquent patient balances and noteworthy patient contact.
Routinely performs insignificant balance write-offs once per month per physician policy.
Communication and Coordination with Physician Office Staff:
Communicates with physician(s) office staff weekly (or more often as needed) regarding
insurance denials, rejections resulting from errors in patient masterfile/insurance policy information.
Performs monthly review with physician(s) regarding charges, payor mix, office collections, A/R aging, changes in reimbursement policy, payments by insurance class, producer, general recommendations.
Assists with the training process of new and existing physician office staff.
Travels to physician’s practice as deemed necessary to communicate/educate on any issues pertinent to the practice management functions.
Works routinely toward maximizing efficiency and cost effectiveness of activities
Recommends action or payment plans on patient accounts over 45 days old with no payment history, also in conjunction with the collection process.
Develops cooperative relations with office staff to effect accurate patient information.
Recommends policy, procedures, and ideas to improve Practice Advantage performance.
Volunteer’s assistance support to co-workers as need indicates.
Maintains up-to-date manual of billing procedure practices unique to account including write off policies and procedures
Assists in the continued education/training process of the Account Specialist I Staff & II Staff
Performs adequate charge master reviews at least annually and more often as deemed necessary and upgrades charges appropriately in accordance with physician(s).
Assists other Account Specialist I & II Staff in the performance of adequate charge master reviews at least annually and more often as deemed necessary and also assist in the upgrading of charges appropriately in accordance with physician(s).
Assists Account Specialist I & II Staff in all day to day Accounts Receivable activities/functions. Provides coding oversite and review on charge sheets and superbills as charges are submitted for posting. Assist Account Specialist as necessary in evaluating codes submitted from client practices and makes recommendations to be presented to physician as appropriate.
Coding Certification & Maintenance
Coding Certification from National Accreditation such as AHIMA or AAPC.
Maintains coding certification at this level with CCS, CPC, or RCC.
Assists in coding audits as audits are contracted with physician practices.
Enhances business and financial management functions of client’s practice
Assists in the Business/financial functions of the Accounts Receivable processes for client(s) by providing adequate feedback, accounts receivable reporting and by also assisting in the maintenance of changes affecting the accounts receivable processes for the individual client and the Practice itself (taking a hands-on role) providing adequate and accurate reporting mechanisms to: cut costs – maximize reimbursement – provide significant training and feedback to staff and physician) Maintains this hands-on role on a consistent basis.
Analyzes and Monitors cost/reimbursement relationship for relevant procedures, medications & supplies for physician practices.
Acts as liaison with Medicare & BCBS regarding medical necessity criteria and precertification issues
Establishes audit controls for lost char