Patient Accounts Specialist

The Patient Accounts Specialist is responsible for a variety of office and clerical tasks relating to insurance billing, claims processing, insurance follow-up, insurance appeals, and patient payment arrangements.

• Responsible for follow up of denied claims from all governmental and commercial contracted payers.
• Perform timely and appropriate validation and follow up of denied claims, including the initial assessment of denials received from the payment poster(s) and the electronic claims center.
• Spot trends to proactively reduce denials and report this information to all billing staff.
• Ability to produce appeals for contractual disputes, state independent reviews, timely filing, pre-existing, coordination of benefits, misrepresentation of coverage, CCI edits, interest, medical necessity, RAC, Medicare redeterminations and Judge Advocate appeals.
• Knowledge of State laws regarding insurance appeals with self-funded groups.  Able to file complaints with State Insurance Commission and work with patients to resolve appeals on their behalf.
• Proactively work with all billing staff including Financial Counselors to reduce and eliminate future denials.
• Assist in resolving insurance contract issues and disputes.
• Responsible for insuring accurate, maximized reimbursement for the organization.
• Submission of claims to grants and foundations on behalf of patients

Requirements

• Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service.
• Maintains confidentiality.
• Responds well to questions.
• Writes clearly and informatively.
• Follows policies and procedures; completes administrative tasks correctly and on time.
• Demonstrates accuracy and thoroughness.
• Is consistently at work and on time.
• Follows instructions, responds to management direction.
• Ability to read and comprehend complex instructions, short correspondence, and memos.
• Ability to write complex correspondence.
• Ability to effectively present information in one-on-one and small group situations to patients, family members, or employees of the organization.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Ability to deal with problems involving a few concrete variables in standardized situations.
• To perform this job successfully, an individual should have knowledge of Database software, Spreadsheet software and Word Processing software.

Desired Degree

High School