Patient Account Specialist - PFS Billing Services

Scripps Health•San Diego, SC

About The Position

This is a Full Time (80 hours every pay period) benefited position, Monday-Friday for day shift. Over time additional hours when needed. Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide. As a Patient Account Specialist, you will be supporting the Billing Services department at our 4S Ranch Business Services location. This role is essential in managing a high volume of hospital Government Insurance/Billing documents, while also performing follow up actions to gather accurate information needed from patients, payers and providers. The ideal candidate is one who thrives in a fast-paced environment and has a passion for insurance and medical claims. As a Patient Account Specialist, you will be responsible for the following: Responsible for working aged reports and credit balances on a regular basis set by department guidelines. Follows-up with insurance carriers timely on unpaid claims until claims are paid or only self-pay balance remains. Does not have claims written off for timely filing. Processes rejections by either making accounts self-pay and generating a letter of rejection to patient or correct any billing error and resubmitting claims to insurance carriers. Keeps updated on all billing requirements and changes for all insurance types. Responsible for responding to all inquiries, billing denials, other correspondence and phone requests in an efficient, timely, and effective manner. Secures needed medical documentation required or requested by insurances. Works with HIM staff to ensure that complete diagnosis/procedure codes and modifiers are reported to insurance carriers as required. Working directly with the insurance company, healthcare provider, liable third parties, and patient to get a claim processed and paid Works to help maintain Accounts Receivable (AR) days at or near target level set by the Hospital Senior Team. Supporting continuous improvement of organization processes and personal knowledge and skills, and maintaining and protecting confidential information Providing excellent customer service through cooperative working relationships, and meeting productivity and quality standards. #LI-JS1

Requirements

Strong working knowledge of managed care plans, insurance carriers, government Payers and payer requirements.
Knowledge of Medical Terminology and Medicare Compliance.
Familiarity with HIPAA privacy requirements for patient information.
Basic understanding of DRG's, Medical ICD9/ICD10 codes and CPT/HCPC Codes.
Ability to multitask and stay organized.
Good verbal and written communication skills.
Detail oriented and ability to prioritize work.
Requires a moderate level of interpersonal, problem solving, and analytic skills.
Knowledgeable on insurance and reimbursement process.
Ability to establish/maintain cooperative working relationships with staff, Medical Staff and providers.

Nice To Haves

Two years of patient accounts experience in a healthcare setting.
Working knowledge of healthcare EPIC software preferred.
Minimum two year experience billing Medicare, Medicaid, Blue Cross and Commercial insurance preferred, three or more years desired.
Knowledge in Excel, Word and basic computer functions such as saving documents, sharing documents
Demonstrate strong computer skills required. (Education may be substituted for experience in some areas.)
Demonstrate knowledge of accounts receivable practices, payer billing and reimbursement procedures and practices.
Working knowledge of hospital UB04, CPT-4, HCPCS, ICD-10 and Revenue codes.
Proficient in institutional insurance billing guidelines using 837I X12 Version 005010X279A1 transactions.

Responsibilities

Responsible for working aged reports and credit balances on a regular basis set by department guidelines.
Follows-up with insurance carriers timely on unpaid claims until claims are paid or only self-pay balance remains.
Does not have claims written off for timely filing.
Processes rejections by either making accounts self-pay and generating a letter of rejection to patient or correct any billing error and resubmitting claims to insurance carriers.
Keeps updated on all billing requirements and changes for all insurance types.
Responsible for responding to all inquiries, billing denials, other correspondence and phone requests in an efficient, timely, and effective manner.
Secures needed medical documentation required or requested by insurances.
Works with HIM staff to ensure that complete diagnosis/procedure codes and modifiers are reported to insurance carriers as required.
Working directly with the insurance company, healthcare provider, liable third parties, and patient to get a claim processed and paid
Works to help maintain Accounts Receivable (AR) days at or near target level set by the Hospital Senior Team.
Supporting continuous improvement of organization processes and personal knowledge and skills, and maintaining and protecting confidential information
Providing excellent customer service through cooperative working relationships, and meeting productivity and quality standards.