Patient Accounts Specialist

Overview

Perform duties in the billing division related to all aspects of the revenue cycle to include data entry, denials, patient interaction, patient account research, and insurance follow-up and extracting appropriate CPT and ICD-10 codes.

Responsibilities

• Review H&P and surgeon’s documentation for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• Analyzes medical records and identifies documentation deficiencies.
• Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies that documentation supports diagnoses, procedures and treatment results.
• Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
• Follows coding conventions. Serves as coding consultant to care providers.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Assists in orienting and training staff.
• Provides ongoing training to staff as needed.
• Create charge encounters by entering CPT and ICD10 codes in the Electronic Health Record (EHR) system.
• Research and resolve insurance denials

• Process – posting claims and manage/work rejections
• Review claim and discuss overdue balance with patients.
• Register and Update patient demographics in IDX
• Calculate patient deductibles and co-insurance payment amount
• Develop payment plans and make payment arrangements for outstanding balances 
• Assists patients/customers with insurance information and balances

• Handles special projects as requested

• Ensures doctor(s) submit notes in a timely manner in order to process claims efficiently.
• Verifies insurance information by calling carrier if applicable.
• Responds to inquiries from patients and researches accounts.
• Must possess the ability and skill to independently work in a team environment.
• Performs other duties as assigned.

Qualifications

Prior experience working with CPT & ICD 10 coding and billing required. Current CPC certification is required, or must obtain within 1 year of employment. 

Medical applications software experience, Allscripts/IDX preferred. Experience with linking ICD10 to CPT codes to support medical necessity. Knowledge of payor guidelines. Experienced with using modifiers. Ability to extract a written diagnosis from the medical record to assign an ICD10 code. 

Location : Location