Patient Accounts Specialist | Insurance Follow-Up

Emerus•The Woodlands, TX

About The Position

The purpose of this position is to assist in managing the company’s outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.

Requirements

High School Diploma or GED, required
2+ years experience in a provider setting (inpatient or outpatient), required
Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required
Experience with medical records or patient accounting systems, required
Knowledge and understanding of state and Federal payment laws, required
Knowledge and understanding of healthcare ‘explanation of benefits’ (EOB’s), required
Experience with a 10-key adding machine, required
Position requires fluency in English; written and oral communication

Responsibilities

Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
Communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
Manage claim details and verify accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes
File appeals for denied claims and follow-up as necessary through appeal resolution
Manage and maintain outstanding patient balances to ensure accurate reporting of company’s accounts receivable
Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
Submit refund requests as necessary
Works special projects as assigned by Supervisor/Director/CFO
Meet position’s goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
Attend staff meetings or other company sponsored or mandated meetings as required
Perform additional duties as assigned
Willingness and ability to work overtime