Account Specialist, FT, Days
Company: Prisma Health
Location: Greenville
Posted on: May 24, 2023
Job Description:
Inspire health. Serve with compassion. Be the difference.Job
SummaryResponsible for processing insurance claims. Coordinates
collections and delinquent unpaid accounts. Oversees claim
processing. Investigates billing problems and assists with error
resolution.Accountabilities
- INSURANCE RESPONSIBILITIES:A. Assists in the processing of
insurance claims including Medicaid/Medicare claims.B. Collects and
enters patient's insurance information into database. C. Assists
patients in completing all necessary forms. Answers patient
questions and concerns.D. Reviews and verifies insurance claims.
Requests refunds when appropriate.E. Processes Medicare
correspondence, signature, and insurance forms. F. Follows-up with
insurance companies and ensures claims are paid within timeframes
as outlined in MA policies and procedures. G. Resubmits insurance
claims that have received no response.H. Answers telephone, screens
calls, takes messages, and provides information.I. Maintains files
with referral slips, Medicare authorizations, and insurance
slips.
- COLLECTION RESPONSIBILITIES: A. Identifies delinquent accounts,
aging period and payment sources. Processes delinquent unpaid
accounts by contacting patients and third party reimbursers.B.
Reviews each account, credit reports and other information sources
such as credit bureaus via computer.C. Performs various collection
actions including contacting patients by phone and resubmitting
claims to third party reimbursers. D. Evaluates patient financial
status and establishes budget payment plans. Follows and reports
status of delinquent accounts.E. Reviews accounts for possible
assignment makes recommendation to Credit Manager and prepares
information for collection agency.F. Assigns uncollectible accounts
to collection agency or attorney via clinic Credit and Collection
policy. Contacts lawyers involved in third-party litigation.G.
Answers inquiries and correspondence from patients and insurance
companies. Develops collection letters.H. Identifies and resolves
patient billing complaints. Researches credit balances.
- CLAIMS RESPONSIBILITIES:A. Oversees claim processing and
payments to third party providers. Answers associated
correspondence. B. Monitors charges and verifies correct payment of
claims and capitation deductions.C. Sends denial letters on claims
and follow-up on requests for information.D. Audits and reviews
claim payments reports for accuracy and compliance. E. Researches
and resolves claim and capitation problems.F. Maintains timely
provider information in physician files. G. Maintains insurance
company manual and distributes information to staff on updates and
changes.H. Maintains required databases and patients accounts,
reports and files.I. Resolves misdirected payments and returns
incorrect payments to sender.J. Answers patients inquires regarding
account balances.K. Appeals denied claims adhering to payer policy
while communicating with MAMC department for further assistance
with claims resolution as appropriate.L. Works all assigned claims
within designated time frame to ensure timely and appropriate
payment
- BILLING RESPONSIBILITES: A. Researches all information needed
to complete billing process including getting charge information
from physicians.B. Works with other staff to follow-up on accounts
until zero balance or turned over for collection. C. Assists with
coding and error resolution.D. Maintains required billing records,
reports, and files.E. Investigates billing problems and formulates
solutions. Verifies and maintains adjustment records.F. Maintains
and enhances current knowledge of assigned payers with regard to
guidelines for billingG. 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.H.
Recommends changes to departmental processes as necessary to
maximize operational effectiveness of the revenue cycle.
- MISCELLANEOUS:1. Maintains strictest confidentiality.2.
Participates in educational activities.3. Performs related work as
required.4. 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.Supervisory/Management
ResponsibilityThis is a non-management job that will report to a
supervisor, manager, director, or executive.Minimum Requirements
- High School diploma or equivalent
- 2 years of experience in billing, bookkeeping, collections or
customer service. Required
Certifications/Registrations/LicensesN/AIn Lieu Of The Above
Minimum RequirementsN/AOther Required Skills and Experience
- Associate Degree in a technical specialty program of 18 months
minimum in lengthpreferred
- Multi-specialty group practice setting experience
preferred
- Intermediate ICD-9 and CPT coding abilities preferred
- Electronic Claims Billing experienceWork ShiftDay (United
States of America)LocationPatewood Outpt Ctr/Med
OfficesFacility2116 Plastics Surgery - PatewoodDepartment21161000
Plastics Surgery - Patewood-Practice OperationsShare your talent
with us! Our vision is simple: to transform healthcare for the
benefits of the communities we serve. The transformation of
healthcare requires talented individuals in every role here at
Prisma Health.
Keywords: Prisma Health, Greenville , Account Specialist, FT, Days, Accounting, Auditing , Greenville, South Carolina
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