SUMMARY:

The Patient Account Specialist is responsible for the timely and accurate claim processing, follow-up and account resolution of all claims. Ensures accurate and complete information appears on the UB-04/CMS 1500 or in the electronic billing system. Communicates with patients, intermediaries and Federal agencies, safeguarding the public relations of the hospital by consistent professional conduct.

ESSENTIAL FUNCTIONS:

1. Reviews and prepares all claims in queue according to the proper method requested by the payer both electronic and hardcopy billing (if required). Corrects any edits needed and adds them to the clearing house. Maintains productivity in line with department standards.
2. Correct any hold bills that are preventing claim submission, to include but not limited to late charges, inquiries. cancellations, and adjustments
3. Identifies and follow up on any unpaid account(s) in a timely manner to assure prompt payment from payers and patients and prevent aging of Accounts Receivable. This includes correspondence, and electronic rejections (NEIC, etc.) received and daily work queue accounts. Maintains productivity in line with department standards.
4. Follow-up staff must continuously identify issues or repetitive errors, which impede the bill generation process.
5. Processes accurate adjustments, write-offs, account reclassifications on claims including but not limited to denials.

a) Researches any incorrect payments, as identified through the Remittance Advice or through follow-up.

b) Processes all correspondence, i.e. mail backs, rejections and inquiries.

1. Keeps an accurate record on all patients under scope of responsibility, which includes keeping accurate information on account activity; provides appropriate file documentation as needed to maintain accurate records on patients’ account financial status.
2. Responsible for being familiar with regulatory changes issued by intermediaries and insurance companies to determine how charges could impact claims processing and communicates with Supervisor such changes.
3. Demonstrates a thorough knowledge and understanding of billing and follow-up policies and procedures in performing job duties and instructing patients and hospital personnel. Routinely uses Patient Accounting Policy and Procedure Manual and other reference materials as necessary to ensure the proper course of action in insurance follow-up and collection.
4. Responsible for providing feedback to the Department Director and/or manager as to the accuracy of the Charge Service Master based on accurate coding as it impacts billing and reimbursement.
5. Utilizes systems under scope at its full capacity. Continues to grow in the user of the computer system as its capabilities expand.

OTHER RESPONSIBILITIES:

Other duties as assigned from time to time, (i.e special projects, audits).

Customer Service.

SUPERVISORY RESPONSIBILITIES:

No.

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

1. High school education or equivalent experience.
2. Experience of three years of specialized billing and knowledge of Insurance terminology.
3. Mathematical ability required to review statistical data on various financial records.
4. 10 key adding machine and typing experience is required. Accuracy is more important than speed. Knowledge of filing systems and copy machines.

LICENSES AND CERTIFICATIONS:

Preferred but not required- Certified Revenue Cycle Specialist (CRCS) Certification.

AGE OF POPULATION SERVED:

Newborn  Infant/Pediatric  Adolescent  Adult  Geriatric  All X  No Patient Care X

PHYSICAL REQUIREMENTS:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.