Patient Accounting Associate II
The purpose of this role is to support the organization by working simple to complex outstanding hospital and/or physician accounts receivable balances to resolution. This should be completed in a manner that meets productivity and quality standards. Research and account follow-up will be required to understand denials, or any other issues preventing payment, and to take the appropriate steps needed to resolve the account.
- Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies.
- Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to: hospital and/or professional claims, governmental and/or non-governmental claims, denial claims, high priority accounts, high dollar accounts, reimbursements, credits, etc.
- Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions; document all activity in accordance with organizational and client policies.
- Communicate professionally (in all forms) with payer resources to include: websites/payer portals, e-mail, telephone, customer service departments, etc.
- Maintain quality and productivity results at a level that meets departmental standards; as measured by a weekly average. More complex and aged accounts will be considered when criteria is set. Based on the complexity of the accounts worked the average could be subject to change.
- Reviews claims data and supporting documentation to identify coding and/or billing concerns.
- Ability to interpret payer contracts and identify contract variances affecting reimbursement.
- Utilize knowledge of the cash posting processing to obtain the necessary information to resolve misapplied payments.
- Demonstrate clear proficiency in third-party billing requirements to include: federal, state, and commercial/managed care payers.
- Interpret claim scrubber edits and takes appropriate action necessary to resolve issues.
- Seek resolution to problematic accounts and payment discrepancies.
- Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution.
- Analyze accounts with critical thinking; consider payer contracts and billing guidelines to ensure one-touch resolution.
- Further responsibilities may include reviewing insurance credit balances to determine root cause and take the steps necessary to resolve the account.
- Identify denials trends, root cause, and A/R impact.
- Serve as a resource to other team members and assist Team Leads with identifying A/R and denials trends.
- Must be 100% self-sufficient with the accounts worked, showing expertise and knowledge working independently to meet production and quality, while utilizing critical thinking and a solution-oriented mindset. Will need to have the ability to take initiative when needed to share trends with leadership.
- Possess thorough understanding of the hospital revenue cycle with specialization in hospital billing and/or physician billing, accounts receivable follow-up, and the account resolution process to include, but not limited to: claims submission, acceptance and adjudication, transaction reviews, adjustment posting, denials & appeals processes, identification of patient responsibility, etc.
- Demonstrate an ability to meet all established department/client quality and productivity standards.
- Proven track record with working complex AR accounts from billing to resolution.
- Experience working complex accounts to include high dollar accounts, accounts with denials, credit balances, and payment variance, meeting 100% production and quality.
- Experience independently submitting technical appeals by following payer specific guidelines.
- Proven experience utilizing payer portals including but not limited to: Availity, Navinet, Experian, Passport, and others. When working in portals must be able to identify the extent to which the payer portal was utilized: check eligibility, benefits, and authorization.
- Must be accustomed to working in a productivity-based environment. Must be able to explain, in depth, how productivity was managed by providing specific examples of prioritizing various accounts.
- Must be able to identify denial trends, root cause, and A/R impact to share with leadership.
- Must be accustomed and have recent experience in industry leading EMR systems (Epic, Cerner, Nextgen, Sorian, EClinicalWorks, Meditech, etc.).
- Knowledge related to third-party billing requirements, including federal, state, and commercial/managed care payers, and demonstrated compliance.
- Ability to efficiently work in a remote environment to include good time management skills and timely communication with co-workers.
- Required proficiency in the use of computers and computer software. Ability to use email and chat functions, navigate websites and portals, intermediate level of experience with spreadsheets, word processing and other required software applications.
- Strong written and verbal communication skills.
Required Experience and Skills
- Minimum Degree: GED or high-school diploma; medical billing, revenue cycle, coding, or other healthcare administrative certifications and/or accreditations are a plus.
- Minimum Years of Experience: 3+ years of experience in medical collections, back-end A/R, and claim review in which denial follow up was worked. Must be experienced in Hospital, Professional/Physician, and/or Third-Party billing and accounts receivable.
- Software/Systems Experience: Epic or relevant EMR system experience required.
*This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.
Recruiting Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Recruiting Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.
Recruiting Solutions expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.