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Patient Account Specialist (262)
Department: PATIENT ACCOUNTING (11998160)
Schedule: Full time
Shift: Day Shift
About Facility:
Hours: 8:00-4:30 Mon-Fri
Job Details:

JOB SUMMARY

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.

ESSENTIAL DUTIES AND RESPONSIBILITIES

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.

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.

Performs other duties as assigned.

COMPETENCIES

To perform the job successfully, an individual should demonstrate the following competencies :

Quality - Follows policies and procedures.; Adapts to changes in the environment.; Demonstrates accuracy and thoroughness.; Looks for ways to improve and promote quality.; Applies feedback to improve performance..

Service - Responds promptly to requests for service and assistance.; Meets commitments.; Abides by MHS confidentiality and security agreement.; Shows respect and sensitivity for cultural differences..

Partnering - Supports organization's goal and values.; Exhibits objectivity and openess to other's views.; Contributes to building a positive team spirit.; Generates suggestions for improving work..

Cost - Conserves organization resources..

Technical Skills - Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

Motivation - Measures self against standard of excellence.

Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently.

Professionalism - Approaches others in a tactful manner; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions.

Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity.

Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions ; Uses equipment and materials properly.

Attendance/Punctuality - Is consistently at work and on time; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Asks for and offers help when needed.

Design - Demonstrates attention to detail.

Technical Skills - Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Oral Communication - Listens and gets clarification; Participates in meetings.

Written Communication - Able to read and interpret written information.

EDUCATION, TRAINING, & EXPERIENCE

High school diploma or general education degree (GED);  one to three months related experience and/or training; or equivalent combination of education and experience.

Previous experience preferred billing third party payers or working with providers to process claims.

WORK ENVIRONMENT

The noise level in the work environment is usually moderate.

WORK CONTACT GROUP

SPECIAL PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.

LEVEL OF SUPERVISION

SUPERVISES

This job has no supervisory responsibilities.

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills

Basic computer skills, familiarity with computers, ability to type on a keyboard, knowledge of spreadsheet and word processing software.


EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Acton Plans.

   
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