Patient Account Specialist - Revenue Cycle HB Billing & Denials

Minimum Qualifications:

High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience.

Job Summary/Description:

The Patient Account Specialist will be responsible for billing all third party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to insure timely and appropriate reimbursement and account resolution.

Job Duties:

• Demonstrates a level of competence and understanding of all state and federal laws, rules and regulations regarding payer billing guidelines.
• Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements.
• Billing payers and/or clients for hospital and/or Professional Patient Accounts.
• Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims.
• Performs online corrections to edited claims according to procedures.
• Performs detailed follow-up activities on assigned accounts according to procedures.
• Responds to daily correspondence according to procedures.
• Identifies denials and underpayments for appeal.
• Reviews, researches and processes denied claims.
• Appeal claims as appropriate according to policies and procedures.
• Updates account information and documents as appropriate within Epic Resolute.
• Processes account adjustments according to policies/procedures.
• Issues payer and/or patient refunds according to policies/procedures.
• Validates accuracy of payments and/or adjustments on accounts.
• Resolves outstanding accounts at required accuracy and productivity requirements.
• Maintains comprehensive knowledge of the work unit assigned.
• Assists in the development of department policies and procedures.
• Adheres to established policies and procedures.
• Adheres to internal controls and reporting structure.
• Maintains open and professional communication with customers, colleagues and vendors.
• Performs well in a team environment.
• Successfully completes competency based training and testing.
• Prioritizes and completes all work in an accurate, effective and efficient manner.
• Assists in the training and mentoring of new employees.
• Reads all announcements and relevant communications relating to job duties.
• Performs related duties as required.
• Participates in team meetings/activities and supports the philosophy and goals of the team and department

Salary Range:  

Actual salary commensurate with experience or range if discussed and approved by hiring authority.