Account Specialist F/T Day
1 week ago
We are seeking a highly skilled Account Specialist to join our team at Prisma Health. As an Account Specialist, you will be responsible for processing insurance claims, coordinating collections, and overseeing claim processing.
Key Responsibilities- Process insurance claims, including Medicaid/Medicare claims, and collect and enter patient insurance information into the database.
- Assist patients in completing necessary forms, answer patient questions and concerns, and review and verify insurance claims.
- Follow up with insurance companies to ensure claims are paid within timeframes outlined in MA policies and procedures.
- Resubmit insurance claims that have received no response and maintain files with referral slips, Medicare authorizations, and insurance slips.
- Identify delinquent accounts, aging period, and payment sources, and process delinquent unpaid accounts by contacting patients and third-party reimbursers.
- Review each account, credit reports, and other information sources, and perform various collection actions, including contacting patients by phone and resubmitting claims to third-party reimbursers.
- Oversee claim processing and payments to third-party providers, answer associated correspondence, and monitor charges and verify correct payment of claims and capitation deductions.
- Research and resolve claim and capitation problems, maintain timely provider information in physician files, and maintain insurance company manuals and distribute information to staff on updates and changes.
- Resolves misdirected payments and returns incorrect payments to sender, and answers patient inquiries regarding account balances.
- Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.
- High School diploma or equivalent OR post-high school diploma/highest degree earned.
- 2 years of experience in billing, bookkeeping, collections, or customer service.
- Associate Degree in a technical specialty program of 18 months minimum in length.
- Multi-specialty group practice setting experience.
- Intermediate ICD-9 and CPT coding abilities.
- Electronic Claims Billing experience.
This is a non-management job that will report to a supervisor, manager, director, or executive. The work environment is a multi-specialty group practice setting.
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