Blending
Care
and Expertise
Patient Account Specialist
Location: Houston, Texas
Date Posted: 19 Dec, 2024
Job Summary:
The Patient Account Specialist is responsible for handling hospital billing, UB04 claims, appeals, corrected claims, and payer interactions. This role involves providing medical collection services, utilizing a strong background in medical collections to resolve accounts placed with TLRA for collection. The Specialist will follow up on accounts, communicate with patients, clients, reimbursement vendors, and external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction are paramount.
Key Responsibilities:
- Provide medical collection services for assigned accounts, focusing on hospital billing, UB04 claims, and appeals.
- Resolve accounts placed with TLRA for collection by performing follow-up activities and account resolution.
- Communicate effectively with patients, clients, reimbursement vendors, and other external entities.
- Ensure compliance with client, state, and federal guidelines during all collection activities.
- Understand and apply the hospital revenue cycle, specializing in billing, follow-up, and account resolution.
- Work with various account types, including hospital/professional claims, governmental/non-governmental claims, denied claims, and high-priority accounts.
- Manage multiple work queues, follow-up on denials, and engage payer websites to ensure timely payment of claims.
- Pursue and follow up on appeals as needed.
- Initiate communication with the coding team and clinical staff when medical necessity or coding-related appeals are warranted.
- Identify denial trends and notify the Supervisor/Manager to prevent future denials and payment delays.
- Recommend solutions for resolution and improvements.
- Adapt to changes in work processes, maintaining performance during periods of transition.
- Communicate professionally with payer resources, including websites, email, phone calls, and customer service departments.
- Maintain a cooperative and positive attitude with clients, management, and colleagues.
- Meet departmental standards for quality and productivity.
Required Qualifications:
- Minimum of 3 years of experience in a customer service call entry environment, with a focus on healthcare billing/collections or collection agency environment.
- Knowledge of general A/R accounts and hospital revenue cycle processes.
- Proficient in PC skills within a Windows environment.
- Solid knowledge and use of Microsoft Word and Excel.
- Ability to professionally communicate with various payer resources and colleagues.
Preferred Qualifications:
- College education, previous insurance company claims experience, or healthcare billing trade school education may be considered in place of formal hospital experience.
- Previous experience in a client service or marketing role, preferably in healthcare or a collection agency environment.
Certifications:
- None required, but relevant certifications in healthcare billing or collections may be a plus.
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