General Summary:
Under general supervision and according to prescribed methods, examines patient accounts in order to respond to
patient questions. In doing so, reviews transactions, insurance claims and payment received, researches medical records
chart for discrepancies, and refiles corrected insurance claims as necessary. Initiates guarantor financial responsibility
discussion on assigned accounts obtaining payment and/or establishing recurrent payment plan. Reviews and determines
appropriate action needed related to claim denials as assigned. In doing so, reviews EOB denial and remark codes to
determine accuracy of claim submitted; verifying payer policy via website or by contacting payer by telephone, fax or web
inquiry when clarification is needed. In completing the inquiry various forms or letters may be submitted with
documentation to obtain appropriate payment and maintain proper status of accounts.
Principal Duties and Responsibilities:
1. Responds to patient questions regarding their account by explaining charges, insurance reimbursement and

respective patient financial responsibility. Researches discrepancies in patients' accounts, initiates insurance
reviews, and forwards documentation of necessary adjustments to appropriate department staff for correction
and claim resubmission. Alerts chronic bad debt accounts and works with those patients on establishing pre-
service payments.

2. Researches rejected insurance claims by reviewing patient chart and account information, corrects data, and

resubmits claim or claim adjustment to insurance company. Monitors claims for payment and contacts insurance
company as necessary to determine reason for delayed payment.

3. Contacts responsible workers compensation entity in order to obtain correct claim filing information and to

determine reason for delayed payment when appropriate.
4. Monitors accounts with outstanding insurance balances by locating and reviewing explanation of benefits, filing

required forms within the filing deadline and submits claims to secondary insurance as necessary. Using
prescribed guidelines, adjusts account balances to reflect prorated amounts.

5. Receives payments from patients, prepares receipts, and properly stores daily funds according to established

guidelines. Establishes payment plans with guarantors.
6. Protects patient’s rights by maintaining confidentiality of personal and financial information.
7. Performs various related duties such as copying materials, sending letters and forms to patients and insurance

companies, obtain estimated charges for services, updates patient account information as necessary, and so
forth.

8. Maintains knowledge of trends and developments in the field by reading appropriate material, and by attending

seminars, conferences and so forth.
9. Files primary and secondary insurance for patients unless instructed otherwise.
10. Communicates with patients, other departments and various clinic staff in a professional and courteous manner at

all times. Works cooperatively with other departments and Clinic staff to improve processes, systems and
communications.

11. Actively participates in the process improvement initiatives and seeks to identify and resolve issues through
teamwork and collaboration.

12. Performs other department duties as assigned.
Knowledge, Skills and Abilities Required:
1. Ability to read and write in order to review patient account transactions, prepare various insurance forms, and

review medical records information and to perform arithmetic calculation in order to verify account balance and
determine adjustments at a level normally acquired through completion of one year post high school vocational,
technical, or business school training.

2. Approximately six to twelve months of work experience with insurance claim processing necessary in order to

understand patient account transactions and department procedures, to research discrepancies and resolve
account errors, and to understand precertification requirements.

3. Interpersonal skills necessary in order to effectively respond to patient inquiries regarding sensitive account

information, to exchange patient data with insurance companies when resolving claim discrepancies, and to
research patient account problems with other department personnel.

4. Analytical skills necessary in order to examine patient account information to locate discrepancies and provide

documentation for insurance claims, and to determine necessary adjustments to accounts.
5. Ability to concentrate and pay close attention to detail for approximately sixty percent of work time when

examining patient accounts, researching discrepancies, and preparing adjustments.