Patient Account Specialist - Third Party Billing
Performs self-pay collections or third party billing/collections which includes a complex review of billing and collection activities. Resolves problems and demonstrates complete understanding of payer and/or patient requirements to ensure timely and accurate payment. Makes independent decisions based on the needs of the patients and/or payer situations.
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.
Third Party Billing and Collections: 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. 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.
Self-Pay Collector: Performs self-pay collections which include complex review of billing and collections activities. Resolves and researches any potential coverage to ensure timely and accurate payment. Has a complete understanding of all options to resolve the balances. Must exhibit strong knowledge of fair debt collections. Meets with patients/families to acquire payment options or complete financial applications for all special programs available to resolve accounts; evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies; explains charges, services, and hospital privacy regarding payment of bills. Experience: Three (3) years of related experience such as medical billing, collections or customer service, preferably in an acute care setting
EDUCATION: High School diploma or General Education Degree (GED); or an equivalent combination of relevant education and experience.
EXPERIENCE: Varies based on position, see above.
LICENSURE OR CERTIFICATION: None required.