Patient Account Specialist - Revenue Cycle #11

Who We Are:

St. Johns Episcopal Hospital is the only hospital providing emergency and ambulatory care to the densely populated, culturally and economically diverse, and medically underserved populations of the Rockaways and Five Towns in southern Queens County and southwestern Nassau County, New York. Celebrating over 110 years of community care, the 257-bed facility provides people of all faiths with comprehensive preventive, diagnostic treatment and rehabilitative services, regardless of ability to pay.

Come Grow With Us!

Type: Full Time

Shift: Days

Hours: 8:30AM - 5:00PM

Pay: $26.35 - $27.71 Hourly

Job Summary:

The Patient Accounts Specialist fulfills the functions of Patient Billing Accounts Pay/Rec Clerk and in addition performs higher level functions related to the revenue cycle process. Assists with the coordination and testing of system updates prior to live implementation, coordinates and responds to internal and external audits requests relative to accounts receivable, processes claims through clearing house platform(s) to determine completeness of billing and correct missing charges, refiles cases in 3M coding system for APC / APG calculation as needed, and performs other receivables assigned duties.

Responsibilities:

• Audit hospital charges to be paid by the insurance carrier and patients in the hospitals billing system as well as processing claims in the hospitals claims clearing house platform(s)

• Process co-insurance charges and claims electronically forwarded to insurance carriers

• Complete computer input documents to generate allowance expected payments and actual payments to individual patients accounts

• Mail statements to patients for remainder of charges not covered by the insurance carriers

• Follow up with telephone, correspondence and with in-person interviews, with both insurance companies and patients to gather required data for the ultimate payment of the hospital bill

• Research and process patient and insurance refunds, where applicable

• Post third party payor remittances, payments and adjustments to appropriate accounts

• Receive and batch remittances from multiple sources and reconciles daily batches

• Address all SPARCS issues related and assigned to Patient Accounts for correction action

• Serve as a staff resource for issues related to the process of re-filing cases in 3M coding system for APC/APG calculation and other patient accounts systems processes

Requirements:

• High School diploma or Equivalency

• Knowledge of state and federal hospital billing regulations 837 billing requirements

• Knowledge of CPT, and ICD-10 terminology and coding

• Knowledge of OMNIPRO, EPACES and EMEVS for online eligibility determinations

• Ability to navigate through insurance company websites to verify claim status

• Knowledge of computer, basic accounting principles, Excel and Word