This position is responsible for the company’s third-party medical claims processing. Claims are prepared and submitted to Medicaid, Medicare, and private insurance companies.
The Patient Accounting Specialist will handle questions, complaints, or problems from insurance companies, Medicaid offices and their associated Managed Care Plans, Medicare regions and their associated Health Maintenance Organizations, and families regarding insurance payments.
Activities, Duties and Responsibilities:
- Verifies all of the information for claims billing is correct in CRM database. Contacts the appropriate person to obtain missing or unclear billing information. Documents all tasks in notes/history.
- Reviews all invoices to determine the correct billing method. Completes claim form through CRM database, or internet web site (if required) ensuring that all fields required by the third party in question are complete and accurate. Attaches required documentation for payment.
- Follows up by phone on all unpaid and denied claims through activities in CRM database. Determines next course of action, which may require re-billing missing claims, denied claims OR sending additional information on pending claims.
- Handles third party customer questions, complaints, and problems once a bill has been submitted. Completes all necessary follow-up in a timely manner so the payment process will not be delayed. Must stay current on follow ups, so billing deadlines are not missed.
- Respond to and interact with customers concerning all aspects of billing through phone, email or regular mail in a prompt and courteous manner.
- Relays changes in Medicaid, MCO, Medicare, HMO regulations discovered by claim denials to all pertinent personnel.
- Maintains confidentiality outlined in privacy portion of the federal Health Information Privacy and Portability Act of 1996.
- Other duties/projects assigned by the Managing Supervisor.
- Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
- Must have excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
- Must have excellent analytical and problem-solving skills.
- Ability to work easily and cooperatively with other departments.
- Ability to work independently and follow through on tasks without direct supervision.
- Ability to work well under pressure in a flexible, diplomatic and expeditious manner.
- Maintains strict confidentiality of patients’ medical records and adherence to all HIPAA and ACHC policies and regulations.
- Must be extremely accurate with attention to details, policies, and procedures.
- Excellent and accurate calculator, and computer skills. Including the ability to use, Microsoft Excel, Microsoft Word, E-Mail.
- Minimum of 2 years of work-related experience desirable.
- Knowledge with billing/collection databases preferred.
- Medical office experience is desirable.
- Must have excellent computer knowledge and accurate keyboard skills.
Span of Control:
This position is responsible for key revenue cycle generation processes that have an impact on the company’s cash flow including but not limited to establishing hard-copy and computerized files, entering third party billing information and subsequent medical billings and ensuring all documentation is present and claims are billed in a timely manner and without error.
This position requires frequent to extensive contact with individuals both inside and outside the company. Due to the nature of the contacts (including phone calls to insurance companies, Medicaid offices, Medicare regions and families with insurance payments) this position requires a 95% or greater English proficiency. Must also maintain the highest-level of confidentiality. All work will be recorded for quality and training purposes.