Account Specialist II - Practice Advantage

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.

Assists in the continued education/training process of the Account Specialist I Staff.

Performs adequate charge master reviews at least annually and more often as deemed necessary and upgrades charges appropriately in accordance with physician(s). 

 

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Qualifications

High School Graduate or higher.   Must have minimal of 3 years’ experience as an Account Specialist or Healthcare Medical Biller.    Prior experience do physician/provider professional fee billing is preferred.  Detailed knowledge and experience of insurance coverage processes.  Experience with computer billing/collection systems and experience filing insurance required. Detailed knowledge and experience of all coding/billing/insurance/processes including detailed coding knowledge and experience consisting of at least ICD10CM, CPT, HCPS, utilization of modifiers, bundling edits, etc for Part B, HCFA 1500 claim filing.  Demonstrated ability to work well with public physicians and staff in a mature responsible self-confident manner. Very good interpersonal/communication ski