Patient Account Specialist - Third Party Billing
Performs third party billing and collections functions which includes a complex review of billing and collection activities. Resolves claim edits and demonstrates complete understanding of payer claim requirements to ensure timely and accurate payment. Ensures timely and proper reimbursements by researching and resolving all aged receivables.
Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.
Ensures UB04 and HCFA 1500 claims and/or self-pay patient accounts are billed in a timely, complete, and accurate manner in accordance with appropriate guidelines.
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
Demonstrates understanding of the entire revenue cycle.
Provides routine daily internal and external interface with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third party payers in order to resolve patient concerns, disputes, and billing audits in order to receive payment.
Assists with problem solving, inquiries, and customer interaction to ensure positive results.
Researches and analyzes any correspondence received related to assigned accounts.
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Analyzes patient accounts, determines non-collectable accounts and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write offs.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Performs related duties as assigned.
EDUCATION: High School diploma or General Education Degree (GED); or an equivalent combination of relevant education and experience.
EXPERIENCE: Three (3) years of related experience such as medical billing or third party collection in a hospital, payer, or physician setting. Technical experience in CMS/Medicaid regulations and/or commercial payer billing requirements. Minimum two (2) years’ experience in a windows environment, including excel.
LICENSURE OR CERTIFICATION: None required.