Patient Account Specialist

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.   

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.

Benefits Eligible

Full-Time Benefit Eligible

Work Shift

Day - 8 Hour or less Shift (United States of America)

Department

8530 Patient Financial Services

Maintains complete and full knowledge of payer(s) assigned to ensure accurate billing and collection of the claims. Validates that the Kaweah Health is being reimbursed by the payer in accordance with government or contract terms.

QUALIFICATIONS

Education

Preferred: High school diploma or equivalent

Experience

Required: Prior Patient Accounting or admissions experience. Comparable medical billing education may be considered.

JOB RESPONSIBILITIES

Essential

Maintains complete and full knowledge of payer(s) assigned to ensure compliance of specific guidelines and rules, as well as ensuring the Kaweah Health is being reimbursed by the payer in accordance with governmental or contract terms. Is a resource to Finance division management regarding the assigned payer.

Brings any reimbursement or compliance concerns to the attention of the Patient Accounting Manager.

Utilizes computer systems and/or billing reports to review all patient registrations or admissions for demographic information, appropriate financial class, insurance company and plan, and charges. 100% accuracy of this information is required to ensure proper recording of revenue, necessary authorizations are obtained, payer classification, correct billing of patient account, and other statistical indicators. Brings any unresolved issues to the attention of their manager.

Audits unbilled reports for potential holdups of patient accounts. Works closely with Medical Records on coding issues, Insurance Verification Clerk on insurance issues and other departments as necessary.

Completes billing process. Ensures all charges are accurate and appropriate. Payer guidelines will be followed during the billing process. After billing has been completed, uses appropriate charge description master (CDM) number to identify the payer and when the account was billed. Works closely with departments on unresolved issues.

Reviews and researches patient account credits and refunds as appropriate to patient and/or payer. For governmental payers, has the credit retracted.

Receives all correspondence and inquiries related to patient accounts and payer contract for which they are responsible. Answers mail and take appropriate action within specified timeframe.

Bills any secondary payers, change financial classes accordingly and sends appropriate collection system letter to patient for co-pays and deductibles owed, denied services, amounts applied to deductible, etc. Uses correct CDM code to identify what secondary payer was billed and when.

Reviews and works aging reports to identify unpaid patient accounts. Follows up with payers for timely reimbursement.

Works to ensure that days in accounts receivable goals are met maintained and/or lowered. Maintains job productivity and quality standards on a consistent basis as established by division management.

Answers phones as a back up to other departmental staff. Takes messages or routes calls as appropriate. As back up, assists customers at the service counter.

Conforms with patient confidentiality standards.

Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.

Performs other duties as assigned.

Addendum (essential for specific dept)

Insurance or managed care payer:

Has complete knowledge of assigned insurance payer, knows contract terms, requirements and payment practices.

Receives prior day's explanation of benefits or remittance advices for assigned payer(s). Reviews to ensure that appropriate contractual adjustments have been taken by payer. Works closely with payer to resolve issues and brings continued problems to the attention of their manager.

Monitors patient acc