Account Specialist F/T Day

Prisma Health•Greenville, SC

5d•Onsite

About The Position

Responsible for processing insurance claims. Coordinates collections and delinquent unpaid accounts. Oversees claim processing. Investigates billing problems and assists with error resolution. All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Assists in the processing of insurance claims including Medicaid/Medicare claims. Collects and enters patient's insurance information into database. Assists patients in completing all necessary forms. Answers patient questions and concerns. Reviews and verifies insurance claims. Requests refunds when appropriate. Processes Medicare correspondence, signature, and insurance forms. Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures. Resubmits insurance claims that have received no response. Answers telephone, screens call, takes messages, and provides information. Maintains files with referral slips, Medicare authorizations, and insurance slips. Identifies delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contacting patients and third party reimbursors. Reviews each account, credit reports and other information sources such as credit bureaus via computer. Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors. Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts. Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency. Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy. Contacts lawyers involved in third-party litigation. Answers inquiries and correspondence from patients and insurance companies. Develops collection letters. Identifies and resolves patient billing complaints. Research credit balances. Oversees claim processing and payments to third party providers. Answers associated correspondence. Monitors charges and verifies correct payment of claims and capitation deductions. Sends denial letters on claims and follow-up on requests for information. Audits and reviews claim payments reports for accuracy and compliance. Research and resolves claim and capitation problems. Maintains timely provider information in physician files. Maintains insurance company manual and distributes information to staff on updates and changes. Maintains required databases and patients accounts, reports and files. Resolves misdirected payments and returns incorrect payments to sender. Answers patients' inquiries regarding account balances. Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate. Works all assigned claims within designated time frame to ensure timely and appropriate payment Research all information needed to complete billing process including getting charge information from physicians. Works with other staff to follow-up on accounts until zero balance or turned over for collection. Assists with coding and error resolution. Maintains required billing records, reports, and files. Investigates billing problems and formulates solutions. Verifies and maintains adjustment records. Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing. Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle. Maintains strictest confidentiality. Participates in educational activities. As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. Performs other duties as assigned.

Requirements

High school diploma or equivalent OR post-high school diploma / highest degree earned.
Two (2) years in billing, bookkeeping, collections or customer service.
Electronic Claims Billing experience.
Maintains strictest confidentiality.
As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.

Nice To Haves

Associate degree in a technical specialty program of 18 months minimum in length.
Multi-specialty group practice setting experience.
Intermediate ICD-9 and CPT coding abilities.

Responsibilities

Processing insurance claims, including Medicaid/Medicare.
Collecting and entering patient insurance information.
Assisting patients with forms and answering questions.
Reviewing and verifying insurance claims.
Processing Medicare correspondence and forms.
Following up with insurance companies on claim status.
Resubmitting insurance claims.
Answering telephone, screening calls, taking messages, and providing information.
Maintaining files with referral slips, Medicare authorizations, and insurance slips.
Identifying delinquent accounts and processing them by contacting patients and third-party reimbursors.
Performing collection actions, including contacting patients and resubmitting claims.
Evaluating patient financial status and establishing payment plans.
Reporting the status of delinquent accounts.
Reviewing accounts for assignment to collection agencies or attorneys.
Answering inquiries and correspondence from patients and insurance companies.
Developing collection letters.
Identifying and resolving patient billing complaints.
Researching credit balances.
Overseeing claim processing and payments to third-party providers.
Sending denial letters and following up on requests for information.
Auditing and reviewing claim payment reports.
Researching and resolving claim and capitation problems.
Maintaining provider information in physician files.
Maintaining insurance company manuals and distributing updates.
Maintaining required databases, patient accounts, reports, and files.
Resolving misdirected payments and returning incorrect payments.
Answering patient inquiries regarding account balances.
Appealing denied claims.
Researching information needed to complete the billing process.
Following up on accounts until zero balance or turned over for collection.
Assisting with coding and error resolution.
Maintaining required billing records, reports, and files.
Investigating billing problems and formulating solutions.
Verifying and maintaining adjustment records.
Maintaining knowledge of assigned payers' guidelines.
Providing training to front office staff on payer rules and guidelines.
Recommending changes to departmental processes.
Maintaining confidentiality.
Participating in educational activities.
Maintaining a neat and professional appearance.
Demonstrating commitment to service.