Patient Account Specialist/SRCC

JOB RESPONSIBILITIESEssentialMaintains complete and full knowledge of payer(s) assigned to ensure compliance of specific guidelines and rules, as well as ensuring the Kaweah Health is being reimbursed by the payer in accordance with governmental or contract terms.

Is a resource to Finance division management regarding the assigned payer. Brings any reimbursement or compliance concerns to the attention of the Patient Accounts Manager.

Utilizes computer systems and / or billing reports to review all patient registrations or admissions for demographic information, appropriate financial class, insurance company and plan, and charges.

100% accuracy of this information is required to ensure proper recording of revenue, necessary authorizations are obtained, payer classification, correct billing of patient account, and other statistical indicators.

Brings any unresolved issues to the attention of their manager. Audits unbilled reports for potential holdups of patient accounts.

Works closely with Medical Records on coding issues, Insurance Verification Clerk on insurance issues and other departments as necessary.

Completes billing process. Ensures all charges are accurate and appropriate. Payer guidelines will be followed during the billing process.

Works closely with other billing staff and the supervisor on unresolved issues. Reviews and researches patient account credits and refunds as appropriate to patient and / or payer.

For governmental payers, has the credit retracted. Receives all correspondence and inquiries related to patient accounts and payer contract for which they are responsible.

Answers mail and take appropriate action within specified timeframe. Bills any secondary payers, change financial classes accordingly and sends appropriate collection system letter to patient for co-pays and deductibles owed, denied services, amounts applied to deductible, etc.

Uses correct CDM code to identify what secondary payer was billed and when. Reviews and works aging reports to identify unpaid patient accounts.

Follows up with payers for timely reimbursement. Works to ensure that days in accounts receivable goals are met maintained and / or lowered.

Maintains job productivity and quality standards on a consistent basis as established by division management.AdditionalAnswers phones as a back up to other departmental staff.

Takes messages or routes calls as appropriate. As back up, assists customers at the service counter. Conforms with patient confidentiality standards.

Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.

Performs other duties as assigned.To lead the staff activities within the billing functions, including coding, claims, payment posting, authorizations and billing follow up to support the revenue cycle management of the practice.

To ensure that all functions are compliant with government regulations, insurance requirements and KH corporate compliance.

QUALIFICATIONS : Education Preferred : Minimum high school diploma or equivalentExperience Required : Prior admissions or patient accounting experience.

Comparable medical billing education may be considered.