Patient Account Specialist

PIONEERS MEMORIAL HEALTHCARE DISTRICT•Brawley, CA

13d

About The Position

The Patient Account Specialist is responsible for timely and accurate claim processing, follow-up, and account resolution. The role ensures complete and accurate information on UB-04/CMS 1500 forms or in the electronic billing system and communicates professionally with patients, intermediaries, and Federal agencies while safeguarding the hospital’s public relations. The specialist reviews and prepares claims according to payer requirements, resolves billing edits and holds, follows up on unpaid accounts, processes adjustments and correspondence, and maintains accurate account records. The role also monitors regulatory and payer changes, communicates relevant updates to the Supervisor, supports accurate charge and coding information, and uses available systems and reference materials to carry out billing and collection procedures. This position has no supervisory responsibilities and operates in a professional office environment using standard office equipment.

Requirements

High school education or equivalent experience.
Three years of specialized billing experience and knowledge of insurance terminology.
Mathematical ability to review statistical data on financial records.
Experience with a 10-key adding machine and typing.
Accuracy is more important than speed.
Knowledge of filing systems and copy machines.

Nice To Haves

Certified Revenue Cycle Specialist (CRCS) certification is preferred but not required.

Responsibilities

Review and prepare claims in the queue according to payer requirements, using electronic or hardcopy billing as needed.
Correct billing edits and add claims to the clearinghouse.
Maintain productivity in line with department standards.
Resolve hold bills that prevent claim submission, including late charges, inquiries, cancellations, and adjustments.
Identify and follow up on unpaid accounts in a timely manner to support prompt payment and prevent accounts receivable aging.
Process correspondence and electronic rejections, including daily work-queue accounts and payer rejections.
Identify recurring issues or errors that impede bill generation and follow up on them.
Process accurate adjustments, write-offs, and account reclassifications, including those related to denials.
Research incorrect payments identified through remittance advice or follow-up.
Process mail-backs, rejections, inquiries, and other correspondence.
Maintain accurate patient account activity and file documentation concerning account financial status.
Stay informed about regulatory changes from intermediaries and insurance companies, assess their potential impact on claims processing, and communicate changes to the Supervisor.
Apply billing and follow-up policies and procedures when performing duties and instructing patients and hospital personnel.
Use the Patient Accounting Policy and Procedure Manual and other reference materials to guide insurance follow-up and collection work.
Provide feedback to the Department Director and/or manager about Charge Service Master accuracy and coding as they affect billing and reimbursement.
Use systems within the role’s scope to their full capacity and continue developing proficiency as system capabilities expand.
Perform other assigned duties, such as special projects and audits, and provide customer service.