Patient Account Specialist

Position Summary

Responsible for billing and collecting patient cost share balances from third party claims and billing and collecting self-pay claims. Generates and mails patient statements and final notices, initiates collection calls and responds to incoming calls from patients and guarantors making payments or inquiring about billing status. Researches and resolves complex billing issues, utilizing knowledge of current hospital and medical billing and reimbursement methodologies.

Works in close coordination with Financial Counselors and Customer Service personnel to support a favorable patient experience.

Responsibilities

• Performs Accounts Receivable Collections by issuing patient statements, making outbound collections calls and handling inbound patient calls to take payments or respond to billing inquiries

• Reviews patient account to ensure account balance accuracy before statement is generated

• Works with Business Services, Financial Counseling, Coding, HIM, Patient Advocacy, and clinical departments to resolve patient inquiries, or billing or patient care complaints

• Researches and resolves claims discrepancies or routes claims issue to appropriate department for resolution

• Processes and posts patient payments to guarantor accounts. Assures that payments not specifically directed by the patient or guarantor are applied per established payment posting logic (programming)

• Analyzes patient accounts receivable to respond to patient billing concerns; escalates to Patient Advocacy when patient questions are related to a patient care complaint

• Identifies billing and coding errors from the EOB posting and works with source departments to facilitate corrections as needed

• Identifies Commercial, Medicare, Medicaid and other coverage, in coordination with the patient; assigns the correct primary and secondary payer information and transfers account to Business Services for processing of corrected claim. Enters notes in the billing system to document corrected billing actions

• As needed for newly identified third party payer coverage, verifies insurance eligibility and benefit information, collects patient co-payments, co-insurances, and deductibles

• Supports Financial Counseling by completing financial assistance screening for patients who express an inability to pay, per Financial Assistance policy. Transfers patient to Financial Counseling Department, as appropriate

• Performs other related duties as assigned

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

Requirements and

Minimum Qualifications

• Associate’s degree in a related field preferred

• 1 year customer service and previous collections experience preferred

• 1 year experience working in a hospital/health care business office or financial clearance department, scheduling, or registration preferred

• Working knowledge of current health insurance reimbursement methodology, hospital and medical billing practices preferred

• Ability to read and explain an Explanation of Benefits (EOB) and Remittance Advice (RA) preferred

• Familiarity with CPT codes, and medical terminology, preferred

• Excellent communication, organizational and analytical skills required

• Knowledge and demonstrated competence working with Microsoft Office software

Working Conditions

• Must be able to lift and move up to 10 lbs

• Must be able to reach arms above or below shoulder height

• Must be able to maintain a sitting position

• Typical equipment used in an office job

• Repetitive movements

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

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