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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.
Job Responsibility:
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
knowledge of Database software, Spreadsheet software and Word Processing software