JOB TITLE: Patient Account Reimbursement & Credentialing Specialist
GENERAL SUMMARY OF DUTIES: Responsible for Clinic and ASC patient accounts that includes, insurance claim filing and follow up, referrals, payment posting, collections, and patient billing inquiries. Responsible for provider credentialing with insurance companies and facilities
SUPERVISION RECEIVED: Reports to Billing Office Supervisor
1. Responsible for credentialing new providers with insurance companies and facilities.
2. Responsible for assuring all providers are in network with the appropriate insurance companies.
3. Responsible for periodic credentialing updates and attestations with insurance companies and facilities.
4. Responsible for the maintenance of patient account aging on a monthly basis and coordinates with team for collections.
5. Responsible for the maintenance and processing of credit balance aging on a monthly basis
6. Responsible for patient account inquiries and assisting patient and/or insurance company
7. Provides electronic insurance filing on account inquiries.
8. Provides posting of payments to patient accounts.
9. Responsible for updating patient demographics and insurance/billing information as necessary.
10. Provides patient account audits as required.
11. Provides verification that denials and/or write-offs on electronic payments post correctly as well as verifying the applicability of the denial.
12. Process denials by contacting the insurance company, verifying medical policy was followed, and sending appeal if necessary
13. Confirms receipt of insurance referral and obtaining patient referral as required and recording of information for efficient workflow
14. Provides coverage for daily payment posting of electronic and manual remits.
15. Provides coverage for generation of patient statements on a monthly cycle basis.
16. Responsible for verification of insurance billing on reference lab invoice.
17. Assists with the maintenance of insurance aging and outstanding insurance claims on a monthly basis.
18. Participates in professional development efforts to ensure currency in health care practice, trends and compliance.
19. Provides cross-training as appropriate.
20. Follows Patient Confidentiality/HIPAA Policy.
21. Various other duties as required or requested by supervisor.
EDUCATION: High school diploma or GED. Prefer associates or bachelor’s degree
EXPERIENCE: Minimum of three to five years insurance, billing, and credentialing experience in health care organization.
1. Knowledge of medical billing/collection practices.
2. Knowledge of third party operating procedures and practices.
3. Knowledge of clinic policies and procedures.
4. Knowledge of HIPAA policies and procedures.
5. Knowledge of Medicare regulations and compliance.
6. Knowledge of CPT and ICD-10 coding and clinic operating policies.
7. Knowledge of grammar, spelling and punctuation to process patient information.
8. Knowledge of patient services principles and techniques.
9. Knowledge of clinic policies/procedures
10. Knowledge of use of office equipment including computer, software, phone system, and other office equipment.
11. Knowledge of customer service concepts and techniques.
12. Knowledge of medical terminology.
1. Skill in customer service principles by creating a pleasant atmosphere, handling calls, and effectively serving as clinic liaison.
2. Interpersonal skills necessary in order to deal effectively and courteously with callers, patients, and families, exchange patient related information with a variety of clinic personnel and interact effectively with providers.
3. The ability to read, understand, and follow oral and written instruction.
4. The ability to sort and file materials correctly by alphabetic or numeric systems.
5. Skill in screening and directing calls in pleasant and expeditious manner.
6. Skill in efficiently operating console and peripherals.
7. The ability to work effectively and initiatively in problem solving.
8. The ability to establish and maintain effective working relationships with patients, employees and the public.
9. Must be personable and outgoing with patients.
10. Ability to work cooperatively as member of clinic's front line service team.
11. Ability to respond to stressful situations in calm and effective manner.
12. Ability to type a minimum of 40wpm.
13. Proficient with ten key skills.
14. Possess basic accounting skills.
15. Have the ability to operate routine software programs.
16. Demonstrate strong organizational skills and time management skills.
ENVIRONMENTAL/WORKING CONDITIONS: Medical Office setting
1. Work requires hand dexterity for office machine operations, frequent stooping and bending.
2. Must be able to sit up to 8 hours a day.
3. Stress from dealing with upset patients and/or situations.
4. Must be able to lift up to 50lbs to waist height.
5. Work may be repetitious at times.
6. Requires corrective vision and hearing within normal range.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.