Job Abstract

Required Education / Experience:

Associates Degree or equivalent. Minimum of five years patient accounts experience. Minimum of two years Epic Revenue Cycle experience.

Job Summary:

The Sr. Patient Account Specialist will be responsible for billing all third party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to insure timely and appropriate reimbursement and account resolution.

Essential Job Functions:

• Demonstrates an expert level of competence and understanding of all state and federal laws, rules and regulations regarding payer billing guidelines
• Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements
• Meets or exceeds QA and Productivity requirements
• Billing payers and/or clients for hospital and/or Professional Patient Accounts
• Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims
• Performs online corrections to edited claims according to procedures
• Performs detailed follow-up activities on assigned accounts according to procedures
• Responds to daily correspondence according to procedures
• Identifies denials and underpayments for appeal
• Reviews, researches and processes denied claims
• Appeal claims as appropriate according to policies and procedures
• Updates account information and documents as appropriate within Epic Resolute
• Processes account adjustments according to policies/procedures
• Issues payer and/or patient refunds according to policies/procedures
• Validates accuracy of payments and/or adjustments on accounts
• Resolves outstanding accounts at required accuracy and productivity requirements
• Assists in the training and mentoring of new employees
• Performs quality assurance reviews
• Assist in the coordination of reporting and feedback to stakeholders
• Maintains comprehensive knowledge of the work unit assigned
• Assists in the development of department policies and procedures
• Adheres to established policies and procedures
• Adheres to internal controls and reporting structure
• Maintains open and professional communication with customers, colleagues and vendors
• Performs well in a team environment

Marginal or Periodic Job Functions:

• Successfully completes competency based training and testing
• Prioritizes and completes all work in an accurate, effective and efficient manner
• Participates in team meetings/activities and supports the philosophy and goals of the team and department
• Assists in the training and mentoring of new employees
• Reads all announcements and relevant communications relating to job duties
• Performs related duties as required.

Salary Range:

Actual salary commensurate with experience.