Patient Accounts Resolution Specialist -- Patient Accounts -- General Hospital

CAMC Health System•Charleston, WV

12d•Onsite

About The Position

The Patient Accounts Resolution Specialist reviews unpaid and underpaid claims to ensure accurate and timely payment in accordance with company policies, payer contracts, and governmental regulations. The role follows up on unpaid or underpaid claims, resolves issues, and thoroughly documents efforts and outcomes. The specialist works with coding and Utilization Review teams to address denials and appeals; uses payer web portals and DDE systems to obtain claim information; contacts payers and physician offices; and ensures requested medical records and itemized statements are submitted and received. The position also resolves Medicare claims in Suspense, rebills claims accurately, follows assigned workflows, and communicates preventable billing errors and system issues to department leadership. The employee must complete orientation and ongoing competency validation to independently perform assigned tasks and duties. The role also includes maintaining required education, providing positive customer service, participating in quality improvement, complying with attendance and scheduling policies, and following organizational and departmental procedures.

Requirements

High school diploma or GED.
1–2 years of collections, customer service, or comparable experience.
Healthcare billing and collection knowledge.
Ability to interpret a payer explanation of benefits (EOB).
Ability to identify and resolve claim issues.
Excellent communication and customer service skills.
Computer and keyboarding skills.
Demonstrate competency through initial orientation and ongoing competency validation to independently perform assigned tasks and duties.
For positions with direct patient contact, possess or obtain by the end of orientation and demonstrate the knowledge and skills for developmentally appropriate patient assessment, treatment, or care, including interpreting information in terms of patient needs, knowledge of growth and development, and understanding the range of treatment needed.

Nice To Haves

Medical terminology background.
5–7 years of related experience.
Knowledge of Microsoft Excel and Word.
Cerner knowledge.

Responsibilities

Review assigned work items daily and resolve at-risk, past-due, and technical-denial claim issues.
Work with coding to resolve coding-related denials.
Work with Utilization Review to resolve authorization-related denials and appeals.
Use payer web portals and DDE systems to obtain claim information needed for resolution.
Contact payers by phone to resolve claim issues.
Contact physician offices to obtain information needed to resolve claims.
Manually and accurately resolve claims in Suspense for Medicare.
Ensure requested medical records and itemized statements are submitted to and received by payers, working with contracted agencies when applicable.
Follow workflows assigned by management.
Rebill claims accurately to avoid denials.
Communicate preventable billing errors and identified system-related issues to the Department Manager, Supervisor, or Team Lead.
Professionally and thoroughly document information necessary to resolve outstanding balances in the encounter timeline.
Complete and document result-driven follow-up.
Maintain and document applicable required education.
Demonstrate positive customer service and co-worker relations.
Comply with the company's attendance policy and departmental pay practices and scheduling policies, including overtime, shift work, and on-call situations.
Participate in department and institution continuous quality improvement activities.
Perform work cost-effectively and in alignment with the organization's mission and strategic plan.
Follow organizational and departmental policies and procedures.
Perform related duties as assigned.