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Account Specialist, FT, Days

2 months ago

Greenville, South Carolina, United States Prisma Health Full time

Job Summary

We are seeking a highly skilled and detail-oriented Account Specialist to join our team at Prisma Health. As an Account Specialist, you will play a critical role in processing insurance claims, coordinating collections, and overseeing claim processing.

Key Responsibilities

  • Insurance Claims Processing
    • Assist in the processing of insurance claims, including Medicaid/Medicare claims.
    • Collect and enter patient's insurance information into our database.
    • Assist patients in completing all necessary forms and answer their questions and concerns.
    • Review and verify insurance claims, requesting refunds when necessary.
    • Process Medicare correspondence, signature, and insurance forms.
    • Follow up with insurance companies to ensure claims are paid within the required timeframes.
    • Resubmit insurance claims that have received no response.
  • Collection Responsibilities
    • Identify delinquent accounts, aging period, and payment sources.
    • Process delinquent unpaid accounts by contacting patients and third-party reimbursers.
    • Review each account, credit reports, and other information sources, such as credit bureaus via computer.
    • Perform various collection actions, including contacting patients by phone and resubmitting claims to third-party reimbursers.
    • Evaluate patient financial status and establish budget payment plans.
    • Follow and report the status of delinquent accounts.
    • Review accounts for possible assignment and make recommendations to the Credit Manager.
    • Assign uncollectible accounts to a collection agency or attorney, following our clinic's Credit and Collection policy.
    • Contact lawyers involved in third-party litigation.
    • Answer inquiries and correspondence from patients and insurance companies.
    • Develop collection letters.
    • Identify and resolve patient billing complaints.
    • Research credit balances.
  • Claims Responsibilities
    • Oversee claim processing and payments to third-party providers.
    • Answer associated correspondence.
    • Monitor charges and verify correct payment of claims and capitation deductions.
    • Send denial letters on claims and follow up on requests for information.
    • Audit and review claim payments reports for accuracy and compliance.
    • Research and resolve claim and capitation problems.
    • Maintain timely provider information in physician files.
    • Maintain insurance company manuals and distribute information to staff on updates and changes.
    • Maintain required databases and patient accounts, reports, and files.
    • Resolve misdirected payments and return incorrect payments to the sender.
    • Answer patient inquiries regarding account balances.
    • Appeal denied claims, adhering to payer policy, while communicating with the MAMC department for further assistance with claims resolution as necessary.
    • Work all assigned claims within the designated time frame to ensure timely and appropriate payment.
  • Billing Responsibilities
    • Research all information needed to complete the billing process, including obtaining charge information from physicians.
    • Work with other staff to follow up on accounts until a zero balance or turned over for collection.
    • Assist with coding and error resolution.
    • Maintain required billing records, reports, and files.
    • Investigate billing problems and formulate solutions.
    • Verify and maintain adjustment records.
    • Maintain and enhance current knowledge of assigned payers regarding guidelines for billing.
    • Provide training to front office staff when hired and retraining as needed or requested regarding specific payer rules and guidelines for physician billing.
    • Recommend changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.
  • Miscellaneous
    • Maintain strict confidentiality.
    • Participate in educational activities.
    • Perform related work as required.
    • As a representative of Prisma Health Clinical Department, maintain a neat and professional appearance, demonstrate commitment to serve at all times, and uphold guidelines set forth in the office manual.

Supervisory/Management Responsibility

This 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/Licenses

N/A

In Lieu Of The Above Minimum Requirements

N/A

Other Required Skills and Experience

  • Associate Degree in a technical specialty program of 18 months minimum in length (preferred)
  • Multi-specialty group practice setting experience (preferred)
  • Intermediate ICD-9 and CPT coding abilities (preferred)
  • Electronic Claims Billing experience