Patient Accounts Coordinator

Job Summary

Reviews, codes, services, and abstracts patient medical records data. Performs coding and reimbursement duties of a more complex level as assigned.

Responsible for billing and collection activities, processing, and submission of accurate claims to third party payors and clients.

The Medical Necessity team is a Coding & Reimbursement team within Patient Financial Services. The team reviews accounts that “fail” coding, regulatory, medical necessity, and payer guidelines for Outpatient services for our Metro facilities. When accounts qualify in the Medical Necessity team’s work queues the team’s responsibility is to ensure that the clinical documentation and regulatory payer guidelines support the diagnoses and procedure codes on the claim. The team reviews Ambulatory Payment Classification (APC) groupers in EPIC. The APC errors include conflicting procedures that are considered invalid, mutually exclusive or a component of another procedure code.

Essential Functions

 

• Monitors the processing of documentation which creates claims for various funding sources through data entry.
• Discusses financial responsibilities with patient/family prior to initiation of services if required by procedure.
• Receives and follows up on incoming correspondence and telephone inquiries regarding medical record information for payment.
• Completes and submits claims according to governmental regulations, agency policies and timeliness standards.
• Edits all claims for accurate pricing, coding, service dates and general demographics, prior to submission to carriers.
• Bills secondary insurance claims with copy of explanation of benefits from primary or secondary payors and adheres to carrier-specific requirements for payments.
• Audits patient accounts for accuracy.
• Reviews claim denials and resubmits claims for reconsideration.
• Ensures completion of revenue posting prior to business system monthly software closure.
• Addresses patient billing questions concerns and complaints.
• Reviews weekly and monthly billing reports for accuracy.
• Reviews preliminary billing lists and completes adjustments and corrections.
• Prepares aging reports of unpaid claims and collects on overdue accounts.

 

Physical Requirements
Requires sitting for long periods of time. Requires bending and may need to lift up to 10 pounds occasionally.

Education, Experience and Certifications
High school diploma or GED required. Previous medical billing and/or follow up experience required. Medicare Billing experience preferred. Position requires a minimum of 2 years’ experience in a medical and/or healthcare financial setting; hospital preferred. Requires the ability to communicate effectively in verbal and written formats.

Atrium Health is one of the nation’s leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region’s largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care.

We’ve been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors’ offices to behavioral health centers to nursing homes.

Our focus: Delivering the highest quality patient care, supporting medical research and education, and joining with partners outside our walls to keep our community healthy.