Trinity Health Physician Account Specialist in Pontiac, Michigan

POSITION PURPOSE

Ensures the financial integrity and Accounts Receivables by performing established financial processes that enable and expedite the billing and collection of professional services.

This includes: ensuring claims are processed according to Federal/Managed Care rules, regulations and compliance guidelines, patient account research and resolution, insurance verification and benefits determination, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance invoices, follow up and resolution of denied claims. Responsible for working correspondence denials and insurance follow up. This must be done in a timely and accurate manner, in accordance with provided work instructions by performing the following duties.

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ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Utilizes aged receivable reports to perform follow-up duties with third party payers and may correct and rebill/status account or transfer to patient responsibility. Monitor and execute work against the assigned Tier(s) and team associated Custom Claim Worklist(s), relational AR Worklist(s), reporting, projects, or team / department goals Review payment vouchers, claim rejections and insurance correspondence to determine the validity of payment amount or rejection reason and takes appropriate action such as rebill/status account securing all the necessary authorizations and documentation required to substantiate and collect for the level of service rendered. Responds to incoming telephone calls, walk-in patients, and correspondence from patients or their representatives, medical office staff and insurance companies concerning billing, assisting to customers understanding with questions or problems. Demonstrates understanding of prevailing regulatory or third party requirements regarding authorization issues, referral issues, and billing. Remains updated on all coding (ICD10 and CPT4) requirement and changes, enhancing reimbursement and maintaining accurate coding of services. Possible coding and charge entry based assigned Tier(s) and associated responsibilities (Specialty Tier(s), CPC) Process patient and third party refunds after thorough analysis determines the refund is valid. Records follow-up action taken on patient accounts in account notes. Supports and conducts one's self in a manner consistent with customer service expectations. Research and resolution of claims based on assignment, the process of which could include: Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals and facilitating their direction to athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims Possible coding and charge entry based assigned Tier(s) and associated responsibilities (Specialty Tier(s), CPC) Ability to run reports for analysis, trending, subdivision of work, or distribution based on direction (both self and managerial) as needed to communicate data of interest, trends of concern or a need. Communicate claims trends resulting in denials or a decrease in payments to management with the payer, provider(s), number of claims, and dollar amount affected. Complete system knowledge relative to worklists, research and resolution of assigned Unpostables, payment batches Associated system knowledge of upstream and downstream impact of work, and ability to research and resolve in athenaNet Ability to run Zero-Pay Worklist, Fully Worked Receivables, complete special project work, review and respond to adjustments / payment data with approval (or initiate appeal) communicating trends and root issues through proper lines of reporting Receive transferred calls or emails from Patient Financial Specialists with patient’s requesting advanced assistance with their account Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims, and state insurance laws Create patient cases to the correct clinical contact for additional information or corrections to be made with the appropriate details of what is needed Meet productivity and quality standards as set by management. Keeps management informed of correspondence and communication problems with service locations Educate and effectively communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes. Assist in the documentation of coding and billing playbooks by providing content expertise. Maintains the confidentiality of information acquired pertaining to patient, physicians, associates, and visitors to St. Joseph Mercy Health System. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Behaves in accordance with the Mission, Vision and Values of SJMHS. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

OTHER FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

*Education:*

  • High School Graduate or GED Equivalent
  • Secondary education, preferred

*Experience:*

  • Understanding of ICD10 and CPT coding and medical terminology.
  • One to two years related work experience in order to perform initial billing to third party payers and all related functional activities for rebilling/follow-up on unpaid accounts using comperterized systems and software.

REQUIRED SKILLS AND ABILITIES

Must have sufficient knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD and OVERPAID status and to make appropriate decisions for resolution Computer and calculator proficiency required. Understanding of government, HMO and commercial insurance plans. Analytical skills necessary in order to interpret information and requirement received from various agencies in order to correctly accomplish required billing and follow-up procedures. Excellent communication skills necessary to gather and exchange information and collaborate with a wide variety of individuals regarding patient account information. Excellent customer service orientation skills necessary in order to deal effectively with various levels of hospital personnel, outside customers and community groups. Ability to prioritize. Demonstrates effective time management skills.

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Job Number: 00110703

Location: Pontiac, MI

Organization Name: Saint Joseph Mercy Health System

Facility: SJSEMI - SJMO On-Campus Professional Bd

Employment Type: Full time

Shift: Day Shift

Hours: 40