Patient Accounts Specialist 2

Overview

Responsible for ensuring claims are sent electronically to third party payers in a timely fashion and unpaid claims are followed up on in 45 days. Performs other duties as assigned.

Responsibilities

Essential Duties and Responsibilities

• Capably completes processing of claims on a daily basis by demonstrating in-depth knowledge of billing procedures by payer. Ensures that there are no claims older than 5 days in their CA queue.

• Understands Claims Administrator and billing edits used to stop a claim from being transmitted electronically. Understands how to research information needed on a per claim basis and how to correct the claim in the McKesson system (either Plus or Star) and follows all procedures related to CA.

• Maintains in depth knowledge of all Federal and State regulations to ensure all claims billed to Medicare and Medicaid are correct and that issues resulting in inaccurate claims are brought to the attention of the supervisor or Director. Is knowledgeable of CPT coding and use of modifiers in payment determinations. Maintains in depth knowledge/understanding of Local Medical Review Policies from CMS and the application of them.

• OR

• Understands various managed care reimbursement methodologies related to both physician and hospital payments. Understands computer system processing to identify possible processing errors. Establishes contacts at the payers to resolve contract issues. Is knowledgeable of CPT coding and use of modifiers in payment determinations.

• OR

• Collects and enters any additional information relating to a patient account in a timely manner. Ensures the Plus and/or Star system is always updated to accurately reflect the current status of an account.

• Ensures all mail/correspondence is worked and remains current on a weekly basis.

• Communicates any backlogs to their supervisor or lead prior to the end of the week.

• Maintains files of correspondence, etc. as necessary as evidenced by easy retrieval of a document based on the department retention policy.

• Ensures follow-up is done on all accounts/claims on their worklist on a daily/weekly basis. Ensures that all claims/accounts have no follow-up dates that fall into previous months.

• Ensures thorough follow-up is done on each account/claim by making all necessary contacts (phone calls, faxes, etc.) needed to obtain a payment date. Calls and verifies that payment will be made by utilizing an appropriate future follow-up date in Star or Plus.

• Prioritizes work effectively in order to prevent backlogs. Communicates workload issues to supervisor or lead. Helps other work group partners to avoid backlogs.

Culture of Excellence Behavior Expectations

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality

• Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service

• Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering

• Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost

• Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

Education and Experience

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

Certification and Licensure

In lieu of experience, completion of the Advanced Patient Billing Class or Certification in Patient Accounting, American Association of Healthcare Administrative Management (AAHAM-CPAT).

Skills and Abilities

Internal candidates must have a performance appraisal score of 400 for the previous two years.

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills

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.

Reasoning Ability

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.

Computer Skills

To perform this job successfully, an individual should have knowledge of Accounting software; Spreadsheet software and Word Processing software. Basic understanding of where and which system houses information, understands the relationship between systems and what purpose each system serves, for example Star and Plus to Claims Administrator or electronic remittances from the payer to Star and Plus.

Special Physical Demands

The Special Physical Demands are considered Essential Job Function of the position with or without accommodations

While performing the duties of this job, the employee is frequently required to sit; Prolonged sitting. handle, finger, feel, reach, talk and hear. The employee is occasionally required to stand, walk, stoop, kneel, crouch and crawl. Medium work exerting 10 to 25 lbs of force or lifting occasionally. Specific vision abilities required by this job include frequent close vision and ability to adjust focus and occasional distance vision. Manual dexterity needed to operate telephone and keyboard.

Level of Supervision

Some independent judgment is required, but alternatives are limited by standard practices or procedures.

Supervises

This job has no supervisory responsibilities.