Patient Accounts Specialist

Summary

Summary: Patient Accounts Specialist is responsible for reviewing, billing, collection, and accounts receivable activities for Pratt Regional Medical Center’s billing department.  Activities include but are not limited to, entering demographics, troubleshooting issues, responding to inbound and outbound billing calls from patients, payment posting, resolving credits, identifying and correcting medical claim errors that may prevent payment, and identifying, correcting, and resubmitting medical claims denied by insurance companies.  Resolving claim edits, working denials, and submitting appeals.  Patient Account Specialists may be responsible for any or all of the following duties, including duties not otherwise assigned.

Essential Duties and Responsibilities:

Payments

• Responsible for EDI transmissions, electronic and manual payment posting
• Resolve electronic remittance errors
• Responsible for recording daily Trubridge posting batches to cash deposit
• Balance payment batches posted in Trubridge to cash deposits and resolve variance
• Resolve payment posting errors
• Research missing checks, payments, and/or EOBs, which may include contacting payors
• Responsible for processing virtual credit card payments from payors
• Responsible for opening mail with checks and routing to the appropriate area/address
• Meet department productivity and quality metrics
•  

Credits

• Responsible for reviewing patient/guarantor accounts and investigating credit balances (includes reviewing overpayments from insurance companies and patients)
• Identify trends causing credits and escalate to other team members for resolution
• Meet department productivity and quality metrics

Customer Service Call Center

• Responsible for answering inbound patient calls
• Making outbound collection calls to patients to obtain information needed to collect payment
• Process credit card payments
• Establish payment plans with patients and complete referral to extended payment plan vendor when applicable
• Identify patients needing financial assistance, explain the financial assistance process and additional documents needed
• Research and troubleshoot issues related to patient balances
• Serve as liaison between patient and other departments as needed
• Processing incoming mail and faxes
• Identify opportunities and report trends to improve patient satisfaction and workflow efficiencies by identifying reasons for patient calls that could have been prevented by education upstream.  Examples would be educating patients on financial policies, financial expectations of services rendered, correct coding, explanation of coverage, system enhancements to identify the proper insurance at registration, correct payment posting, and medical necessity warnings.
• Meet department productivity and quality metrics

Patient Balances

• Review and process financial assistance applications, complete follow-up with patients for missing documents
• Review past due accounts to determine the eligibility of placement with a collection agency
• Review patient credit balances to determine eligibility for patient refund
• Resolve balances for deceased patients via surviving spouse updates, estate searches, and the filing of estate claims
• Process notices from bankruptcy court and takes appropriate actions on accounts so patients are not billed inappropriately
• Process return mail, update address, and follow-up levels as applicable
• Process attorney ROI billing requests
• Meet department productivity and quality metrics

Claim Processing

• Responsible for researching patient billing claims to correct claim errors
• Understand respective payor requirements so claims are processed correctly
• Familiar with NCD/LCD edits, incidentals/inclusive, and bundling rules, etc.
• Work with multiple teams/departments to resolve issues
• Meet department productivity and quality metrics

Insurance Denials

• Responsible for researching, identifying errors, and correcting claims denied by insurance companies
• Responsible for writing appeal letters to insurance companies
• Research refund requests from payor organizations
• Responsible for preliminary audit of billing code errors before claims resubmitted from denial
• Responsible for becoming a subject matter expert on the payor policies
• Payment posting corrections/adjustments and ability to distribute payments
• Meet department productivity and quality metrics

Insurance Follow-Up

• Responsible for following up with insurance companies for unpaid claims
• Responsible for communicating and resolving problems with the provider representatives when applicable
• Payment posting corrections/adjustments and ability to distribute payments
• Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage claim rejection/no pays
• Meet department productivity and quality metrics

Client Accounts

• Responsible for reviewing all accounts at the beginning of the month to make sure they are ready for statements
• Work with customers on any billing questions they have
• Client refunds

Education/Experience: Basic healthcare and insurance terminology (required).  High School Graduate or equivalent (required).  Post-high school education (preferred).  1-3 years of billing experience or related clerical experience, with an understanding of Medicare, Medicaid, Health Maintenance Organization, and commercial insurance plans, as well as an understanding of ICD10 and CPT coding and medical terminology (required).  Two years of medical billing or related clerical experience (with completion of billing program and certification in billing) (preferred).