Healthcare Account Resolution Specialist

6 days ago

Anaheim, California, United States KPC GLOBAL MEDICAL CENTERS INC. Full time
Job Description

Job Title: Patient Account Specialist I

Company: KPC Global Medical Centers Inc.

Job Summary:

We are seeking a highly skilled Patient Account Specialist I to join our team. As a Patient Account Specialist I, you will be responsible for performing account follow-up from third-party payers, including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental third-party payers.

Key Responsibilities:

  • Analyze Inpatient and outpatient accounts and resolve unpaid, Identify problem accounts and escalate as appropriate.
  • Contacting payors, perform timely follow-up through direct phone calls, provider claims websites, correspondence, appeals, etc.
  • Able to prepare and submit strong appeals that result in Revenue Recovery for all types of denials including contract underpayments, billing issues, payor error denials, etc.
  • Maintains current knowledge of Payer policies and contract rates, able to resolve accounts with discrepancies from expected payment to ensure Payers are in payment compliance with their contracted terms that pertain to payment methodologies and reimbursement practices.
  • Identify patterns, trends, and root-causes in collection workflow and Payer performance and repots the management providing input on appropriate steps/action to take. Provides account-level support as needed to AR vendors.
  • Perform all necessary duties in the Patient Accounting Systems: Updating Insurance Plan Codes, Redistribute Revenue, Requesting Rebills, Updating Denial Module, Updating Status, etc.
  • Updating account with proper documentation action taken to secure payment/Resolve account.
  • Review EOB's, remits and payer correspondence in the course of performing account follow-up and escalate any identified issues to the appropriate area for review and response to expedite claim resolution.
  • Work with patients and guarantors resolve payer requests and discrepancies to promptly resolve pending claims
  • Assists management with completing special AR projects as needed. Demonstrates the ability to complete the project with minimal management intervention. Partners with CBO management to prepare payer packets/spreadsheets of outstanding claims for meetings between CBO and payer representatives.
  • Provides training and education to CBO team members as requested by management. Assisting newly hired team members with answers to questions.
  • Meet or exceed daily productivity and quality standards established by management, remain at or above team average.
  • Maintain Compliance and HIPAA standards at all times
  • Perform other duties and functions as assigned

Requirements:

  • High School Diploma (Additional equivalent experience above the preferred minimum may substitute for the required level of education).
  • Minimum of 2 year of collection experience within a hospital setting, with strong emphasis on managed caree contract and appeals/underpayment collection activities.

Skills & Abilities:

  • Knowledge of collection techniques and collection laws (i.e. AB1455, Knox-Keene Act, Health & Safety Codes, etc.)
  • Knowledge of medical terminology and CTP/HCPS codes
  • Knowledge of networks, IPA's, HMO's, PPO's and PCP's and contract affiliations.
  • Demonstrated skill working in a team-oriented structure to achieve goals
    • Persistent, ability to overcome objections, ability to remove barriers
    • Effective written and verbal communication skills
    • Strong listening skills, ability to follow written and/or verbal instructions
    • Goal Oriented, and seeks to consistently meet aggressive daily, weekly, and monthly production and quality goals
  • Strong analytical skills, proficient with spreadsheets

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