Medical Biller : Patient Accounts Spec. I

JOB DESCRIPTION

Medical Biller: Patient Account Specialist I

Essential Duties and Responsibilities, while maintaining or exceeding 95% of established productivity goals and quality standards:

  • Review charges, patient information, an insurance information prior to billing to minimize underpayment, denials and re-bill attempts.
  • Verifies successful import of claims from host system daily. Reconciling both number of claim count as well as dollars of daily import.
  • Works additional daily reports (72-hr report, prior day rejection report, etc.) to ensure these claims are added timely to the daily transmission.
  • Timely submission of clean, accurate claims of all hospitals assigned either electronic or paper according to payer/hospital requirements and following specific state and federal guidelines per established procedures. To include primary, secondary, and tertiary insurance companies with the appropriate explanation of benefits (EOB).
  • Works errors and halted claims daily. Ensures additional transmission of the corrected claims are completed by end of day or designated time depending on facility.
  • While promoting a paperless environment, selects and prints any claims designated as paper (once errors have been corrected) and identifying potential electronic customers.
  • Mails paper claims daily attaching any additional pertinent documentation necessary to ensure prompt adjudication and payment of the claim.
  • Assure claims needing additional information from facility (i.e. medical records, authorization numbers etc.) is added to appropriate request log to ensure timely completion of claims transmission.
  • Consistently follows established processes and procedures for all assigned accounts and projects to ensure prompt payments and account resolutions, ensuring proper account documentation that is clear, concise and includes all pertinent information.
  • Makes appropriate and necessary corrections to patient account information after verification from the facility as needed to ensure timely correction and submission of claim. Immediate and appropriate escalation of payor trends and issues to management which impact cash, aging and processes.
  • Ensures professional verbal and written communication with facilities, clients and co-workers following established guidelines. Obtains management approval when necessary to communicate with external clients about internal processes and procedures.
  • Follows and maintains patient, account and client confidentiality at all times. Adheres to HIPAA and Compliance Policy Guidelines, guidance of direct manager/supervisor as well as company policy. Seeks assistance when needed from direct manager/supervisor, as well as daily time keeping and attendance policy.
  • Acts in accordance with company's core values of Integrity, Initiative, respect, commitment, performance and customer satisfaction.

Educational and Experience Requirements:

  • High School diploma or GED.
  • Minimum of two (2) years hospital claims billing experience
  • Rules and Guidelines governing billing activities
  • Specific Knowledge of Commercial, Third Party Insurance Accounts including but not limited to Medicare, Managed Care, HMO, PPO, Auto and Work Comp.
  • Basic Computer Knowledge:
    • Programs: Microsoft Word, Excel.
    • Software: SSI, ePremis, Emdeon, etc.

LOCATION

Plano, Texas 75093

PAY

$18

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