Patient Accounts Specialist, Home Health and Hospice - FT

Mercyhealth Wisconsin and Illinois•Janesville, WI

6d•$18 - $27

About The Position

ESSENTIAL DUTIES AND RESPONSIBILITIES Processes claims on a daily basis by demonstrating in-depth knowledge of billing procedures by payer and ensures claims being worked remain timely per department standards. Understands Epic/Brightree billing edits used to stop a claim from being transmitted electronically and understands how to research information as needed to correct the claim Maintains in-depth knowledge of all Federal and State regulations to ensure all claims billed to Medicare and Medicaid are correct and that issues resulting in inaccurate claims are brought to the attention of the supervisor. Is knowledgeable of CPT/HCPC coding and use of modifiers in payment determinations. Understands various managed care reimbursement methodologies related to department payment Collects and enters information relating to patient accounts in a timely manner and ensures Epic/Brightree system is updated to accurately reflect the current status of patient accounts. Understands computer system processing to identify possible processing errors and establishes contacts at the payors to resolve contract issues. Ensures all insurance related mail/correspondence is worked and remains current Prioritizes work effectively to prevent backlogs and ensures follow-up is done on all accounts/claims on their worklist on a daily/weekly basis, ensuring that all claims/accounts have no follow-up dates that fall into previous months and notifies supervisor of any backlogs. Works independently to identify and resolve claim denials and rejections. Understands and navigates payer portals, websites and manuals. Interprets and post EOBs. Investigates and resolves patient inquiries. Performs all functions related to the collection of delinquent accounts, including follow up phone calls, resubmission of claims to third party payers, collections letters, and processing accounts for collection agencies. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) ADDITIONAL REQUIREMENTS Passing the Driver’s License Check and/or Credit Check (for those positions requiring). Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check. Must be able to follow written/oral instructions. OTHER SKILLS AND ABILITIES Language Skills Ability to read and comprehend simple instructions, short correspondence, and memos. Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. Computer Skills To perform this job successfully, an individual should have knowledge of Accounting software; Spreadsheet software and Word Processing software. Basic understanding of where and which system houses information, understands the relationship between systems and what purpose each system serves. WORK ENVIRONMENT The noise level in the work environment is usually quiet Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure. INFORMATION ACCESS Partner may access patient care information needed to perform their job duties. WORK CONTACT GROUP Partners, physicians, patients/family, visitors, vendors SPECIAL PHYSICAL DEMANDS The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this job, the employee is frequently required to sit; Prolonged sitting. handle, finger, feel, reach, talk and hear. The employee is occasionally required to stand, walk, stoop, kneel, crouch and crawl. Medium work exerting 10 to 25 lbs of force or lifting occasionally. Specific vision abilities required by this job include frequent close vision and ability to adjust focus and occasional distance vision. Manual dexterity needed to operate telephone and keyboard. LEVEL OF SUPERVISION Work requires a moderate level of independent judgment along with good interpretive and interpersonal skills with justification and accountability to department leadership

Requirements

High school diploma or general education degree (GED)
Passing the Driver’s License Check and/or Credit Check (for those positions requiring).
Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.
Must be able to follow written/oral instructions.
Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
Ability to deal with problems involving a few concrete variables in standardized situations.
knowledge of Accounting software; Spreadsheet software and Word Processing software.
Basic understanding of where and which system houses information, understands the relationship between systems and what purpose each system serves.

Responsibilities

Processes claims on a daily basis by demonstrating in-depth knowledge of billing procedures by payer and ensures claims being worked remain timely per department standards.
Understands Epic/Brightree billing edits used to stop a claim from being transmitted electronically and understands how to research information as needed to correct the claim
Maintains in-depth knowledge of all Federal and State regulations to ensure all claims billed to Medicare and Medicaid are correct and that issues resulting in inaccurate claims are brought to the attention of the supervisor.
Is knowledgeable of CPT/HCPC coding and use of modifiers in payment determinations.
Understands various managed care reimbursement methodologies related to department payment
Collects and enters information relating to patient accounts in a timely manner and ensures Epic/Brightree system is updated to accurately reflect the current status of patient accounts.
Understands computer system processing to identify possible processing errors and establishes contacts at the payors to resolve contract issues.
Ensures all insurance related mail/correspondence is worked and remains current
Prioritizes work effectively to prevent backlogs and ensures follow-up is done on all accounts/claims on their worklist on a daily/weekly basis, ensuring that all claims/accounts have no follow-up dates that fall into previous months and notifies supervisor of any backlogs.
Works independently to identify and resolve claim denials and rejections.
Understands and navigates payer portals, websites and manuals.
Interprets and post EOBs.
Investigates and resolves patient inquiries.
Performs all functions related to the collection of delinquent accounts, including follow up phone calls, resubmission of claims to third party payers, collections letters, and processing accounts for collection agencies.