Patient Account Specialist

Essential Job Functions: The person in this role may act in either all, one, or some of the following functionalities: Coding, Posting, Claim Resolution, or Benefits Coordination. Specifics of functional areas listed below.

Coding: 

• Reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments
• Perform ICD-10-CM, CPT and HCPCS coding for reimbursement
• Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
• Assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented information.  Assures the final diagnoses and operative procedures as stated by the physician are valid and complete.  .
• Abstracts all necessary information and assigns codes (ICD-10, CPT  & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Promotes positive customer relations for the Marietta Eye Clinic.
• Edits (claim scrubbing)
• Charge entry, assignment of ICD-10 code (reasonability, validity)
• Electronic claim submission and rejection follow up
• Co-managed Surgery coordination and reporting

Posting:

• Independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion. 
• Accurately post or record information regarding collection receipts. 
• Processes and files information regarding collection receipts. 
• Quick evaluation and detail oriented. 
• Research oriented and capable. 
• Files correspondence, records, and reports. 
• Bank and Bank Partner liaison
• Bank Deposit reporting and balancing
• 835 file management, deposit tracking
• Timely application of payments and denials
• Co-managed Surgery coordination and reporting

Claims Resolution:

• Reviews reports (aged trial balance, aging reports, etc.) to ensure timely follow-up and resolution of accounts for assigned payors.
• On a daily basis, researches and corrects denials received for assigned clients.
• Documents all correspondence with patients, insurance carriers and clients.
• Receives payments from patients via phone or in-person.
• Responds to requests for information from patients, insurance carriers and clients within 2 business days.
• The claims resolution function/position is responsible for following-up and resolving all unpaid insurance claims for assigned payors.

Benefits Coordination: 

• Working Clearwave system to accurately display correct insurance for claim filing
• To ensure all services for MEC have appropriate insurance benefit coverage as well as authorization and notification in place prior to all outpatient elective\non-elective scheduled services and within contractual guidelines for urgent and emergent services. 
• Responsible for completing work lists timely. 

Competencies:

• Ability to communicate in a calm, orderly, and non-threatening manner
• Ability to work with interruptions and to manage multiple priorities 
• Ability to analyze an accounts receivable aging report and work associated accounts to completion in an organized and timely manner
• Ability to multi-task
• Good organizational and time management skills
• Must possess strong customer service and interpersonal skills to interact effectively with patients and insurance company representatives

General Minimum Education and Background Requirements - specifics by function listed below:

• High school diploma or GED. 
• Healthcare Experience preferred

Coding: CCS, CCS-P or CPC certified or certification in process, 4+ years Ophthalmology experience

Posting: College Degree or High School Diploma, 4+ years Ophthalmology experience, Experience with managed care contracts, Payment posting experience is preferred

Claims Resolution: CPC certified or certification in process, Medical Practice experience 2+ years

Benefit Coordination: Minimum of one year experience in a hospital admitting/registration practices insurance and managed care areas