Account Specialist F T Day

**Inspire health. Serve with compassion. Be the difference.** **Job Summary** Responsible for processing insurance claims. Coordinates collections and delinquent unpaid accounts. Oversees claim processing. Investigates billing problems and assists with error resolution. **Essential Functions** * All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health.  Serve with compassion.  Be the difference. * Assists in the processing of insurance claims including Medicaid/Medicare claims. * Collects and enters patient's insurance information into database. * Assists patients in completing all necessary forms.  Answers patient questions and concerns. * Reviews and verifies insurance claims.  Requests refunds when appropriate. * Processes Medicare correspondence, signature, and insurance forms. * Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures. * Resubmits insurance claims that have received no response. *  Answers telephone, screens call, takes messages, and provides information. * Maintains files with referral slips, Medicare authorizations, and insurance slips. * Identifies delinquent accounts, aging period and payment sources.  Processes delinquent unpaid accounts by contacting patients and third party reimbursors. * Reviews each account, credit reports and other information sources such as credit bureaus via computer. * Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors. * Evaluates patient financial status and establishes budget payment plans.  Follows and reports status of delinquent accounts. * Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency. * Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy.  Contacts lawyers involved in third-party litigation. *   Answers inquiries and correspondence from patients and insurance companies.  Develops collection letters. * Identifies and resolves patient billing complaints.  Research credit balances. * Oversees claim processing and payments to third party providers.  Answers associated correspondence. * Monitors charges and verifies correct payment of claims and capitation deductions. * Sends denial letters on claims and follow-up on requests for information. * Audits and reviews claim payments reports for accuracy and compliance. * Research and resolves claim and capitation problems. * Maintains timely provider information in physician files.    * Maintains insurance company manual and distributes information to staff on updates and changes. * Maintains required databases and patients accounts, reports and files. * Resolves misdirected payments and returns incorrect payments to sender. * Answers patients' inquiries regarding account balances. * Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate. *  Works all assigned claims within designated time frame to ensure timely and appropriate payment * Research all information needed to complete billing process including getting charge information from physicians. * Works with other staff to follow-up on accounts until zero balance or turned over for collection.      * Assists with coding and error resolution. * Maintains required billing records, reports, and files. * Investigates billing problems and formulates solutions.  Verifies and maintains adjustment records. * Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing * Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing. * Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle. * Maintains strictest confidentiality. * Participates in educational activities. * As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. * Performs other duties as assigned. **Supervisory/Management Responsibility** * This is a non-management job that will report to a supervisor, manager, director, or executive. **Minimum Requirements** * Education - High School diploma or equivalent OR post-high school diploma / highest degree earned. Associate degree in a technical specialty program of 18 months minimum in length preferred * Experience - Two (2) years in billing, bookkeeping, collections or customer service. **In Lieu Of** * NA **Required Certifications, Registrations, Licenses** * NA **Knowledge, Skills and Abilities** * Electronic Claims Billing experience * Multi-specialty group practice setting experience preferred * Intermediate ICD-9 and CPT coding abilities preferred **Work Shift** Day (United States of America) **Location** Ctr Family Medicine/Woodward **Facility** 2126 Endocrinology **Department** 21261000 Endocrinology-Practice Operations Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.