[Hiring] Patient Accounts Specialist III @Orlando Health

Role Description

The Patient Accounts Specialist III is responsible for coordinating efforts to resolve complex accounts and ensuring representatives’ interactions with patients are consistent and compassionate during billing and follow-up activities. This role is also responsible for collaborating with ancillary departments and third-party payers on efforts related to follow-up, denials, and appeals.

Responsibilities

• Resolves inappropriate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.
• Utilizes specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account’s ability to pay after initial rejection from payer.
• Coordinates duplicate billings, coordination of benefits, medical records or clinical resumes as needed to expedite payment of insurance claims.
• Identifies trends in payer non-compliance and informs management and managed care liaison if not able to resolve with payer.
• Works closely with training preceptors in educating team members on Mentor issues and other educational issues.
• Demonstrates a thorough knowledge of all third-party reimbursement requirements and/or thorough knowledge of collection agency procedures and Fair Debt Collection Practices Act (FDCPA).
• Assists Patient Accounts Specialist Lead with the planning and organizing of departmental activities as needed.
• Handles special projects as assigned.
• Analyzes claims to determine the reasons for discrepancies, processes denials and appeals; examines claims to ensure payers are complying with contractual agreements.
• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.
• Communicates directly with payers to follow up on outstanding claim denials, responds to payer inquiries and concerns, and works to develop and maintain positive relationships with payers.
• Responsible for account follow-up for all assigned accounts.
• Maintains system work queues based on electronic payers' error reports as assigned including but not limited to DNB, Claim Edits, Front End Rejections, and No Response from payers, Variances, underpayments, overpayments, and denials.
• Collaborates with payer contracting and other areas of the revenue cycle if necessary to resolve issues pertaining to a claim payment.
• Helps to work and resolve accounts from other team members’ workloads to prevent backlogs and fills in as needed for absent team member.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Qualifications

• High School diploma or GED required.
• Must complete Orlando Health team member development within 6 months of hire date.
• Works proficiently with Microsoft applications (Outlook, Word, Excel, PowerPoint).
• HFMA Certified Revenue Cycle Representative (CRCR) certification received within six (6) months.
• One (1) year experience as a Patient Accounts Specialist II or minimum of three (3) years’ experience in a related field (medical billing/collections/managed care).
• Associate degree in Healthcare Administration, Communications, Business Finance, or related area of study may substitute for 2 years of related experience.