Patient Account Specialist

Kaweah Health•Visalia, CA

1d•Onsite

About The Position

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in its acute care hospital, specialized health centers and clinics. The eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care. The Patient Account Specialist maintains complete and full knowledge of assigned payer(s) to ensure accurate billing and collection of claims, and validates that Kaweah Health is being reimbursed by the payer in accordance with government or contract terms. This role is essential for ensuring compliance with specific guidelines and rules, and for being a resource to Finance division management regarding assigned payers.

Requirements

Prior Patient Accounting or admissions experience.
Comparable medical billing education may be considered.
High school diploma or equivalent.

Responsibilities

Maintains 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 Accounting 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.
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.
After billing has been completed, uses appropriate charge description master (CDM) number to identify the payer and when the account was billed.
Works closely with departments 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.
Answers 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.
Has complete knowledge of assigned insurance payer, knows contract terms, requirements and payment practices (for Insurance or managed care payer).
Receives prior day's explanation of benefits or remittance advices for assigned payer(s) (for Insurance or managed care payer).
Reviews to ensure that appropriate contractual adjustments have been taken by payer (for Insurance or managed care payer).
Works closely with payer to resolve issues and brings continued problems to the attention of their manager (for Insurance or managed care payer).
Monitors patient accounts for secondary payer reimbursement (for Insurance or managed care payer).
Gets electronic remittance advice (R/A) ready for the Accounts Receivable Clerks (for Medicare payer).
Distributes Medicare mail (for Medicare payer).
Reviews DRG worksheet for accuracy of reimbursement (for Medicare payer).
Reviews all denied changes for appropriateness (for Medicare payer).
Reviews the Pending Billing List report and deletes non-covered services (for Medicare payer).
Checks for overlapping claims through accounts receivable inquiry (ARI) (for Medicare payer).
Reviews and processes recurring accounts according to procedure (for Medicare payer).
If responsible for professional billing, processes these bills according to procedure (for Medicare payer).
Reviews and follow up on the DDE system (for Medicare payer).
Maintains full and complete knowledge of the regulations governing the Medi-Cal payer (for Medi-Cal payer).
Reviews the Pending Billing List report and/or the Final Accounts and Cycle Billed report (for Medi-Cal payer).
Follow up is completed according to procedure (for Medi-Cal payer).
Reviews and processes R/A's following procedure (for Medi-Cal payer).
Reviews MEDTRIEVE data to identify problems in billing (for Medi-Cal payer).
Reviews statistical data with their Manager to maximize reimbursement (for Medi-Cal payer).
Reviews Medi-Cal TAR Dashboard weekly for any follow up on approved or denied TARs (for Medi-Cal payer).
Responsible for the administration of the Computer Collection letter service interface (CCI) process (for Self-pay accounts).
Prepares and completes the bad debt write-off and assignment to the collection agency (for Self-pay accounts).
Acts as a liaison to the collection agency and works with patients regarding hospital accounts assigned (for Self-pay accounts).
Responsible to identify patient accounts that may qualify for charity care (for Self-pay accounts).
Works with patients who inquire about charity program (for Self-pay accounts).
Monitors patient accounts pending the Medi-Cal disability process and/or TCMS program (for Self-pay accounts).
Responsible for the estate lien filing in the case of deceased patients to assure that the Kaweah Health receives payment on accounts (for Self-pay accounts).
May be responsible for educating individuals in the Patient Accounting Department on new processes and/or payment regulations (Lead responsibility).
May be assigned to develop training curriculum on new processes (Lead responsibility).
Provides department staff with information regarding updates or changes (Lead responsibility).
May serve as a Subject Matter Expert (SME) for systems issues and claim payment issues (Lead responsibility).
Identifies, investigates, and appropriately communicates account errors in order to prevent further errors (Lead responsibility).
Proactively and critically analyzes departmental processes and products, makes continuous improvements (Lead responsibility).
Keeps the Director of Patient Financial Services informed of any potential issues or areas of concern on an ongoing basis (Lead responsibility).