The Patient Accounts Specialist-Medical - I is primarily responsible for capturing and reviewing all billing codes prior to electronic claims filing, while verifying accuracy and adherence to payer specific coding guidelines for a multi-specialty community health center. This position requires a working knowledge of CPT, HCPC, and ICD codes, as well as the ability to extract information from medical records. Patient Account Specialists also serve as a communication link with the clinical staff and are expected to communicate with them as needed while adhering to proper billing and coding guidelines.
Knowledge, Skills & Abilities
• Reads, speaks, understands and writes proficiently in English.
• Works independently and is self-directed.
• Works effectively in a team environment.
• Problem-solves with creativity and ingenuity.
• Organizes, prioritizes, and coordinates multiple activities and tasks.
• Works with initiative, energy and effectiveness in a fast-paced environment.
• Produces work in high quantity and quality.
• Remains calm and effective in high pressure and emergency situations.
• Use of multi-line telephones and other office machines.
• 10-Key: 150 kpm with a 97% accuracy rate.
• Knowledge of medical terminology.
• Knowledge of HIPAA regulations and compliance.
• Ability to make decisions regarding sensitive information.
• Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.
• Knowledge of dental terminology.
• Knowledge of healthcare revenue cycle functions, including documentation, coding, and billing guidelines.
• Knowledge of government rules and regulations as it pertains to compliant billing practices, using National Correct Coding Initiative (NCCI), and third party payer rules.
• Bilingual skills.
• High school graduate or equivalent.
• Graduate of an accredited Medical Billing Certificate program.
• Customer service related experience working with the general public (1 year).
• ICD-10 coding experience (1 year); or a combination of equivalent education and work experience.
• CPT-4 coding experience (1 year); or a combination of equivalent education and work experience.
• Data entry experience (1 year).
• Working with insurance/billing in a healthcare setting/insurance organization.
• Working with private and/or government third party reimbursement.
• CDT-5 coding experience.
• Healthcare information systems, such as electronic health record and practice management systems experience (1 year).
• Working with low income, multi-ethnic populations.
• Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) or Coding Specialist (CCS) certified by the American Health Information Management Association (AHIMA).
Job Specific Functions/Performance Expectations:
1. Utilizes CPT, ICD, and HCPCS coding, as well as correct modifier usage and verifies proper CPT and ICD coding is entered in the practice management system based on the level of service provided and documented by the provider.
2. Verifies insurance coverage and submits claims to insurance companies.
3. Post daily charges submitted from electronic health record and audit their accuracy. Review and finalize daily summary reports prior to the close of the day.
4. Communicate effectively and respectfully, both in verbal and written form, with providers or clinical staff to obtain missing or incomplete information.
5. Consult with Certified staff to receive written approval before changing codes, including codes listed on current delegation list.
6. Prepare and submit clean claims to various insurance companies, following the specified protocol of the insurance company, and research front-end claim rejections and work cooperatively to resolve discrepancies.
7. Processes reports to clinics of charge entry corrections and tracks their return.
8. Adheres to established quality and quantity standards of the department, including participating in quality reviews for performance improvement.
9. Serves as a resource for staff on all aspects of insurance programs, discount applications, provider coding, payment plans and patient payment processing.
10. Performs A/R resolution.
11. Processes discount fee adjustments and verifies tracking data entered into discount fee database. Assists patients in completing applications and qualifying for discount fee program.
12. Assists patients in setting up payment plans and completes payment plan contracts.
13. Ensures all customer service inquires have been addressed. This includes researching patient questions regarding accounts/statements and initiates appropriate corrections, adjustments and/or resubmission of claim(s). Reconciles patient credit balances and initiates refund requests.
14. Ensures compliance with records management guidelines by scanning various documents, including, but not limited to, statement verifications, collections, OB billing and invoices.
15. Adheres to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care.
We offer competitive wages and a comprehensive benefits package designed to address health, time off, retirement and career-advancement needs. We also offer an additional $0.75/hour for those who test proficiently in a second language.
To learn more and to apply for this position, please visit our website www.CHCsno.org to complete an online application and/or submit your resume for consideration.
Join a team that loves what they do and cares about those they serve.
CHC is an Equal Employment Opportunity/Affirmative Action Employer (EEO/AA)/At-will employer.