Patient Accounts specialist, Durable Medical Equipment

Responsible for ensuring claims are sent electronically to third party payers in a timely fashion and unpaid claims are followed up on in 45 days. Performs other duties as assigned.

• Capably completes processing of claims on a daily basis by demonstrating in-depth knowledge of billing procedures by payer. Ensures that there are no claims older than 5 days in their CA queue.
  
• Understands Claims Administrator and billing edits used to stop a claim from being transmitted electronically. Understands how to research information needed on a per claim basis and how to correct the claim in the McKesson system (either Plus or Star) and follows all procedures related to CA.
  
• Maintains in depth knowledge of all Federal and State regulations to ensure all claims billed to Medicare and Medicaid are correct and that issues resulting in inaccurate claims are brought to the attention of the supervisor or Director. Is knowledgeable of CPT coding and use of modifiers in payment determinations. Maintains in depth knowledge/understanding of Local Medical Review Policies from CMS and the application of them.
  
• OR
  
• Understands various managed care reimbursement methodologies related to both physician and hospital payments. Understands computer system processing to identify possible processing errors. Establishes contacts at the payers to resolve contract issues. Is knowledgeable of CPT coding and use of modifiers in payment determinations.
  
• OR
  
• Collects and enters any additional information relating to a patient account in a timely manner. Ensures the Plus and/or Star system is always updated to accurately reflect the current status of an account.
  
• Ensures all mail/correspondence is worked and remains current on a weekly basis.
  
• Communicates any backlogs to their supervisor or lead prior to the end of the week.
  
• Maintains files of correspondence, etc. as necessary as evidenced by easy retrieval of a document based on the department retention policy.
  
• Ensures follow-up is done on all accounts/claims on their worklist on a daily/weekly basis. Ensures that all claims/accounts have no follow-up dates that fall into previous months.
  
• Ensures thorough follow-up is done on each account/claim by making all necessary contacts (phone calls, faxes, etc.) needed to obtain a payment date. Calls and verifies that payment will be made by utilizing an appropriate future follow-up date in Star or Plus.
  
• Prioritizes work effectively in order to prevent backlogs. Communicates workload issues to supervisor or lead. Helps other work group partners to avoid backlogs.
  

In lieu of experience, completion of the Advanced Patient Billing Class or Certification in Patient Accounting, American Association of Healthcare Administrative Management (AAHAM-CPAT).

The Special Physical Demands are considered Essential Job Function of the position with or without accommodations
While performing the duties of this job, the employee is frequently required to sit; Prolonged sitting. handle, finger, feel, reach, talk and hear. The employee is occasionally required to stand, walk, stoop, kneel, crouch and crawl. Medium work exerting 10 to 25 lbs of force or lifting occasionally. Specific vision abilities required by this job include frequent close vision and ability to adjust focus and occasional distance vision. Manual dexterity needed to operate telephone and keyboard.