Patient Accounts II Specialist
7 days ago
As a System Coordinator, Patient Accounts II at Nexus Health Systems Ltd, you will serve as the secondary gatekeeper for our Business Office. This role is responsible for handling Central Business Office incoming telephone calls, correspondence, and patient account documentation for accounts assigned aged 61+. Your primary goal is to ensure timely and accurate collections per the contract.
Responsibilities:
1. Respond to routine telephone calls or route them to the appropriate staff member as needed.
2. Confirm admission documentation from facilities and CBO billers, ensuring claim accuracy compared to assigned payers according to contract guidelines.
3. Communicate internally/externally to collect additional patient information for timely collections and contract compliance.
4. Verify claims were billed and received for assigned accounts.
5. Assemble and maintain sequential patient financial folders, confirming claims were billed and correspondence matches the patient account when filing completed EOBs.
6. Request rebill claims if payers identify no claim on file or claim denied, providing requests to billers and obtaining necessary information for rectification.
7. Pursue unpaid claims past contract requirements for 100% of total charges.
8. Confirm electronic claims have been received with no rejections, requesting clarification from billers for rejected claims.
9. Document payment, adjustment, and patient responsibility daily upon receipt of EOBs or verification electronically.
10. Submit adjustments within 24 hours of posting payments or receiving EOBs, resolving claims within the same month of payment posting.
11. Document collection efforts taken on each account billed for claims aged 60+ days, noting all actions taken.
12. Mandatory daily work on 35+ accounts from aging, documenting collection efforts and interactions with payers via phone, lockbox, or online.
13. Prepare and summarize accounts actions for monthly CEO AR call for accounts aged 90+.
14. Respond to correspondence within 24 hours of receipt date.
15. Coordinate patient documentation with facility personnel for appeals or rectification purposes.
16. Forward denial correspondence to relevant staff for appeal assistance.
17. File bills, appeals, and communication in patient charts accordingly.
18. Identify credit balances monthly and prepare adjustments for refunding credits before the end of each month for Federal and State-funded agencies (e.g., Medicare, Medicaid).
19. Credit balances on non-Federal or State-funded claims are prepared on adjustment sheets and forwarded to Refund Pending for payer request.
20. Work assigned accounts twice per month, following up every 7-14 days based on billing methods.
21. Pull paid accounts monthly from patient files, confirming completeness and order before storage.
22. Identify internal/external changes affecting reimbursement, assisting other CBO employees as needed.
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