PFS Pt Acct Denial Spclst - PFS Hospital

Kettering Health Network•Miamisburg, OH

About The Position

Under the direction of the Patient Accounts Manager or Patient Accounts Supervisor and guidance of the Team Lead the Patient Accounts Specialist is highly involved in all aspects of medical billing, and is responsible for escalated follow-up and denial work. Participates in training and auditing of Patient Account Representatives. Works special projects as assigned. Effective in identifying and analyzing problems. Generates alternatives and identifies possible solutions. Timely resolution of claim edits allowing timely claim submission Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards Ability to work independently as well as collaboratively within a team environment Excellent problem-solving skills Creative ability to escalation of appeals Excellent verbal, written and customer service communication skills. Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Requirements

High School diploma or equivalent required
Minimum of one years’ experience in health care denials
Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
Experience with managed care contract terms and federal payer guidelines
Experience with medical necessity guidelines and care coordination/case management functions
Experience with hospital billing (UB92 form) and coding requirements
Understanding of Revenue Cycle Processes
In depth understanding of explanation of benefits (EOB's)

Nice To Haves

Experience in Microsoft tools
Epic EMR Experience (Preferred)
Relay Health/ePremis Experience (Preferred)

Responsibilities

Responsible for escalated follow-up and denial work
Participates in training and auditing of Patient Account Representatives
Works special projects as assigned
Effective in identifying and analyzing problems
Generates alternatives and identifies possible solutions
Timely resolution of claim edits allowing timely claim submission
Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards
Ability to work independently as well as collaboratively within a team environment
Excellent problem-solving skills
Creative ability to escalation of appeals
Excellent verbal, written and customer service communication skills