Account Specialist

Job Summary

Responsible for processing insurance claims. Coordinates collections and delinquent unpaid accounts. Oversees claim processing. Investigates billing problems and assists with error resolution.

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:
  Inspire health. Serve with compassion. Be the difference.
• Assists in the processing of insurance claims including Medicaid/Medicare claims.
• Collects and enters patients insurance information into database.
• Assists patients in completing all necessary forms. Answers patient questions and concerns.
• Reviews and verifies insurance claims. Requests refunds when appropriate.
• Processes Medicare correspondence, signature, and insurance forms.
• Follows-up with insurance companies and ensures claims are paid within time frames as outlined in MA policies and procedures.
• Resubmits insurance claims that have received no response.
• Answers telephone, screens call, takes messages, and provides information.
• Maintains files with referral slips, Medicare authorizations, and insurance slips.
• Identifies delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contacting patients and third party reimbursors.
• Reviews each account, credit reports and other information sources such as credit bureaus via computer.
• Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors.
• Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
• Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.
• Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy. Contacts lawyers involved in third-party litigation.
• Answers inquiries and correspondence from patients and insurance companies. Develops collection letters.
• Identifies and resolves patient billing complaints. Research credit balances.
• Oversees claim processing and payments to third party providers. Answers associated correspondence.
• Monitors charges and verifies correct payment of claims and capitation deductions.
• Sends denial letters on claims and follow-up on requests for information.
• Audits and reviews claim payments reports for accuracy and compliance.
• Research and resolves claim and capitation problems.
• Maintains timely provider information in physician files.
• Maintains insurance company manual and distributes information to staff on updates and changes.
• Maintains required databases and patients accounts, reports and files.
• Resolves misdirected payments and returns incorrect payments to sender.
• Answers patients' inquiries regarding account balances.
• Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.
• Works all assigned claims within designated time frame to ensure timely and appropriate payment.
• Research all information needed to complete billing process including getting charge information from physicians.
• Works with other staff to follow-up on accounts until zero balance or turned over for collection.
• Assists with coding and error resolution.
• Maintains required billing records, reports, and files.
• Investigates billing problems and formulates solutions. Verifies and maintains adjustment records.
• Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing.
• Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.
• Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.
• Maintains strictest confidentiality.
• Participates in educational activities.
• As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.
• Performs other duties as assigned.

• Th…