Patient Accounting Spec Iii

7 days ago

Orlando, United States Orlando Health Full time

Position Summary:
The Patient Accounts Specialist III is responsible for coordinating efforts to resolve complex accounts and ensuring representatives’

interactions with patients are consistent and compassionate during billing and follow-up activities. This role is also responsible for collaborating with ancillary departments and third-party payers on efforts related to follow-up, denials, and appeals.

**Responsibilities**:
**Essential Functions**
- Resolves inappropriate payments with insurance carriers that are not in compliance with payer contracts or governmental agency

rates on individual accounts
- Utilizes specialized knowledge of contracts, regulatory or contractual billings guidelines to determine an account’s ability to pay after initial rejection from payer
- Coordinates duplicate billings, coordination of benefits, medical records or clinical resumes as needed to expedite payment of insurance claims
- Identifies trends in payer non-compliance and inform management and managed care liaison if not able to resolve with payer
- Works closely with training preceptors in educating staff on Mentor issues and other educational issues
- Demonstrates a thorough knowledge of all third-party reimbursement requirements and/or thorough knowledge of collection

agency procedures and Fair Debt Collection Practices Act (FDCPA).
- Assists Patient Accounts Specialist Lead with the planning and organizing of departmental activities as needed.
- Handles special projects as assigned
- Analyzes claims to determine the reasons for discrepancies, processes denials and appeals; examines claims to ensure payers are complying with contractual agreements.
- Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner
- Communicates directly with payers to follow up on outstanding claim denials, responds to payer inquires and concerns, and works to develop and maintain positive relationships with payers.
- Responsible for account follow-up for all assigned accounts.
- Maintains system work queues based on electronic payers' error reports as assigned including but not limited to DNB, Claim Edits, Front End Rejections, and No Response from payers, Variances, underpayments, overpayments, and denials.
- Collaborates with payer contracting and other areas of the revenue cycle if necessary to resolve issues pertaining to a claim payment.
- Helps to work and resolve accounts from other staff members’ workloads to prevent backlogs and fills in as needed for absent staff
- Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
- Maintains compliance with all Orlando Health policies and procedures.

Qualifications:
**Education/Training**
- High School Graduate or GED required.
- Must complete Orlando Health staff development within 6 months of hire date.

**Licensure/Certification**
- HFMA Certified Revenue Cycle Representative (CRCR) certification received within six (6) months

**Experience**
- One (1) year experience as a Patient Accounts Specialist II or Minimum of four (4) years’ experience in a related field (medical

billing/collections/managed care). Associate degree in Healthcare Administration, Communications, Business Finance, or related

area of study may substitute for 2 years of related experience.

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