Required Education / Experience:

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

Job Summary:

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.

Essential Job Functions:

•Demonstratesalevelofcompetenceandunderstandingofallstateandfederallaws,rules andregulationsregardingpayer billingguidelines

•Demonstratesabasicunderstanding ofCPT, IC-9,ICD-10, HCPCS,modifier codingas well asPOS requirements

•Billing payersand/orclients for Hospital and/or Professional Patient Accounts

•Resolves Payer rejectionsfrombillingsystemdailytobill submithospital and/orphysiciansclaims

•Performsonlinecorrections toedited claimsaccording toprocedures

•Performsdetailed follow-upactivities onassignedaccountsaccording toprocedures

•Responds to dailycorrespondence accordingto procedures

•Identifiesdenialsand underpaymentsfor appeal

•Reviews, researches and processesdeniedclaims

•Appealclaims as appropriateaccordingtopoliciesandprocedures

•Updates accountinformationanddocuments as appropriatewithinEpicResolute

•Processes account adjustments accordingtopolicies/procedures

•Issues payer and/orpatientrefunds accordingtopolicies/procedures

•Validates accuracyofpaymentsand/oradjustmentsonaccounts

•Resolves outstandingaccounts atrequired accuracy and productivity requirements

•Maintains comprehensiveknowledgeofthework unit assigned

•Assists inthe development ofdepartmentpolicies andprocedures

•Adheres toestablished policies and procedures

•Adheres tointernal controls andreporting structure

•Maintainsopenandprofessional communicationwithcustomers, colleagues andvendors

•Performswell in ateamenvironment

Marginal / Periodic Job Functions

•Successfullycompletes competencybasedtraining andtesting

•Prioritizes andcompletes all work inanaccurate,effectiveandefficient manner

•Participatesinteammeetings/activitiesandsupportsthephilosophyandgoalsoftheteamand department

•Assists inthetrainingand mentoring ofnewemployees

•Readsall announcementsandrelevant communications relating to jobduties

•Performsrelated duties as required.

Salary Range

Actual salary commensurate with experience.

Work Schedule

Monday through Friday, 8am to 5pm and as needed on occasion.