patient account specialist

North East Medical Services

<div>SUMMARY OF POSITION: 
The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.
<h1 class="jobSectionHeader">ESSENTIAL JOB FUNCTIONS:</h1><ul><li>
Reviews, edits, processes, and submits electronic and hardcopy claims to various payers (Medicare, Medicaid, Managed Care, and Private Insurance) for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.</li><li>
Maintains up-to-date knowledge of medical billing requirements for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.</li><li>
Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.</li><li>
Edits charge/claim details and corrects submission errors to ensure accuracy.</li><li>
Researches and resolves outstanding claims on aging reports to minimize delays in reimbursement.</li><li>
Responds to payer requests and remittance advices promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.</li><li>
Under the guidance of the Patient Account Specialist II, addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.</li><li>
Posts charges and submits claims for NEMS physicians&rsquo; hospital visits.</li><li>
Provides training and support to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.</li><li>
Adheres to policies and procedures for billing records retention.</li><li>
Acts as a liaison between physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.</li><li>
Performs additional duties as assigned by management.</li></ul><h1 class="jobSectionHeader">
</h1><ul><li>Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.
</li><li>Working experience in a healthcare or FQHC setting is preferred</li><li>
Working experience with Epic PB Resolute is preferred</li><li>
Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO &amp; PPO), CPT, and ICD-10 CM</li><li>
Must have excellent analytical and communication skills</li><li>
Must be proficient in computer skills</li><li>
Ability to write business correspondence</li><li>
Strong organizational skills to coordinate multiple, varied billing processes simultaneously</li><li>
Upholds high customer service standards in a demanding and complex health care organization</li><li>
Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels</li>
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic 
<li>
</li></ul>LANGUAGE:<ul><li>
Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)</li>
Fluent in other languages is an asset 
<li>
</li></ul>STATUS:<ul><li>
This is an FLSA Non-exempt position.
</li><li>This is not an OSHA high-risk position.</li>
This is a Full Time position. 
<li>
</li></ul>NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).</div>

PATIENT ACCOUNT SPECIALIST I

GoHealth Urgent Care

<div>You&rsquo;re more valuable than ever &ndash; And that&rsquo;s just how we&rsquo;ll make you feel.
Summary 
The Patient Account Specialist is responsible for taking all inbound phone calls, researching customer issues, collecting customer information, collecting payments from customers, responding to all customer inquiries via fax/email/calls.<div> 
Qualifications 
Education Required: 
<ul><li>High School Diploma or GED</li></ul></div><div> 
Work Experience Required: 
<ul><li>3+ years of healthcare, billing, or service experience</li></ul></div><div> 
Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.: 
<ul><li>3 years Medical Billing experience</li><li>CPAR &ndash; Certified Patient Account Representative</li><li>Associate&rsquo;s degree in business administration or related field</li><li>Medical insurance billing and claims processing</li><li>Epic or eClinicalWorks experience</li><li>Bilingual (Spanish)</li></ul></div><div>
Knowledge, Skills, and Abilities 
<ul><li>This role is patient facing and involves interaction and collaboration with other</li></ul>
departments and requires excellent judgment and interpersonal skills. 
<ul><li>Strong interpersonal skills including sound judgement while working with cross functional departments.</li><li>Understanding of basic medical terminology and common healthcare documentation.</li><li>Highly experienced in Microsoft Excel and Word for data entry, reporting, and</li></ul>
documentation. 
<ul><li>Strong working knowledge of medical billing codes such as Current Procedural Terminology</li><li>(CPT) and International Classification of Diseases (ICD) coding for accurate billing and claims processing.</li><li>Exceptional phone and communication skills with the ability to interact effectively across departments and with customers.</li><li>Ability to organize and prioritize tasks efficiently in a fast-paced environment.</li><li>Proficient in navigating computer systems and performing mathematical calculations related to customer accounts and billing.</li><li>Ability to maintain strict customer confidentiality in compliance with HIPAA and company policies.</li><li>Demonstrated ability to follow through with customer inquiries and resolve issues with professionalism and sound judgment.</li><li>Demonstrate flexibility and open mindedness when approaching problem solving and adapting to changing workflows or priorities.</li><li>Ability to calculate deductibles and co-insurance accurately.</li><li>Ability to read and interpret Explanation of Benefits (EOBs).</li><li>Skilled in performing collection activities related to follow-up and account resolution.</li><li>Ability to identify under and overpayments from payors and take appropriate action.</li><li>Experience with third party payor portals for eligibility verification, claim status and account resolution.</li></ul></div><div> 
Essential Duties and Responsibilities 
Administrative and Data Accuracy 
<ul><li>Accurately update and maintain customer demographic and insurance information.</li><li>Update and document patient account clearly and thoroughly to include information received and given during patient interaction.</li><li>Conduct thorough review of patient accounts to verify that required documentation is properly scanned and recorded, ensuring no unnecessary or duplicate documentation requests are made.</li></ul>
Customer Service and Communication 
<ul><li>Deliver high-level customer service to internal customers, payors and urgent care centers.</li><li>Provide exceptional service to customers, ensuring a positive and professional experience.</li><li>Manage each customer inquiry through resolution to include collaborating with internal teams as needed and ensuring timely follow-up.</li><li>Address service-related issues professionally when interacting with customers, guests, physicians and team members.</li><li>Communicate clearly with customers regarding medical and financial matters via phone, email and other communication channels.</li><li>Serve as an effective extension of Company urgent care centers, supporting their mission and values.</li><li>Maintain composure and focus while managing multiple tasks and customer interactions in a high-pressure environment.</li><li>Actively listen to patients to identify financial needs and assist with financial assistance applications when appropriate.</li><li>Minimize patient escalations through one-call resolution.</li></ul>
Patient Account Management and Collections 
<ul><li>Responsible for collecting unpaid customer balances and assisting with credit card payments.</li><li>Provides effective review of accounts leading to patient collection of outstanding balances.</li><li>Documents and updates patient accounts information for all payment and contested balances.</li><li>Performs research and analysis of account issues to timely and accurately resolve accounts.</li><li>Ability to review an account and offer prompt pay discounts to increase collections.</li><li>Accurately and timely submit for patient adjustments to satisfy balances if applicable.</li></ul>
Insurance and Billing Analysis 
<ul><li>Accurately calculate customer deductibles and co-insurance amounts based on insurance plan details and service charges.</li><li>Review and interpret Explanation of Benefits (EOBs) from insurance carriers to ensure appropriate account handling and customer communication.</li><li>Reviews patient claims to articulate the reason for outstanding balances, including claim review, over/underpayment identification, claim non-submittal, contractual adjustments, deductibles and overall patient responsibility.</li><li>Ability to review claims and take appropriate action, including identifying why a claim denied and resubmitting for processing.</li><li>Validating commercial insurance, including patient eligibility, referrals and authorizations as necessary to secure carrier payment.</li></ul>
Internal Communication and Collaboration 
<ul><li>Maintain consistent daily communication with Team and Section leaders.</li><li>Share relevant information with team members to support collaboration and continuity of care.</li><li>Appropriately document any barriers in issue resolution and escalate as needed for review.</li><li>Assist colleagues with tasks and responsibilities when time permits.</li><li>Appropriately identify and assign tasks and responsibilities to internal departments when additional action is required.</li></ul></div><div>
GoHealth Core Values 
GoHealth&rsquo;s Core Values, listed below, are essential functions of this position: 
<ul><li>Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront.</li><li>Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency through process and other forms of innovation.</li><li>Diversity &amp; Inclusion: Fosters diversity and inclusion, to be able to better understand team members, our customers and partners. Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed.</li><li>Courage &amp; Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect.</li><li>Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities.</li></ul>
Additional Requirements 
<ul><li>Office Environment: Tasks may be conducted within a climate-controlled office setting.</li><li>Physical Activity: The role may require the ability to lift, carry, push, or pull materials,</li></ul>
supplies, and equipment (up to 15 lbs.) Duties typically involve a combination of sitting, 
standing, and walking, with frequent changes in position. 
<ul><li>Travel: Travel may be required, including travel between facility locations, remote</li></ul>
facilities, and out-of-town destinations as needed (0-10%) 
<ul><li>Safety Equipment: May require the use of safety equipment for infection prevention.</li></ul>
Internet Requirements for Remote Call Center Employees 
To ensure an optimal and seamless customer experience, the following internet connection 
requirements must be met by all the call center employees working from home. 
<ul><li>Connection Type:</li></ul>
o A hardwired (Ethernet) connection is mandatory to ensure stability and 
reliability. 
o Wireless (Wi-Fi) connections are not permitted for work purposes due to potential 
signal fluctuations, interference, and latency issues. 
<ul><li>Minimum Internet Speed:</li></ul>
o Download speed: At least 100 Mbps 
o Upload speed: At least 10 Mbps 
o These speeds are required to handle voice, video calls, and data transmission 
simultaneously. 
<ul><li>Latency (Ping):</li></ul>
o The network latency must not exceed 100ms to avoid delays in communication. 
<ul><li>Internet Service Provider (ISP):</li></ul>
o The employee must subscribe to a reliable ISP that provide high-speed broadband 
services (e.g.,Fiber Optic, Cable). 
o DSL, satellite, or mobile hotspot connections are not recommended due to higher 
latency and potential service disruption. 
<ul><li>Backup Internet Connection (Optional but Recommended):</li></ul>
o Employees should have a backup internet source (e.g.,secondary broadband or 
mobile data) in case of primary service disruption. 
<ul><li>Testing and Compliance:</li></ul>
o Employees are required to perform a speed test using a reliable tool (such as 
Speedtest by Ookla) before the start of their shifts. 
o A record of compliance may be requested periodically to ensure adherence to these 
guidelines. 
<ul><li>Equipment:</li></ul>
o Employees are responsible for ensuring that they have the appropriate modem, 
router, and Ethernet cable to meet these standards. 
o The router should be placed in a location that minimizes interference and 
maximizes the signal strength to the modem. 
[DO NOT EDIT BELOW THIS LINE] 
_________________________________________________________________________________________________________ 
Note: This Job Description is not inclusive of all the duties of the position. You may be asked by Leaders 
to perform other duties. Leadership may revise this job description at any time. 
Equal Employment Opportunity Statement 
The Company and its affiliates, joint venture partners and entities under common management are Equal Opportunity Employers. They do not discriminate based on race, color, religion, national origin, age, sex, disability, veteran status, sexual orientation, gender identity, or any other protected status under federal, state, or local law. 
 
ADA Accommodation Statement 
Reasonable accommodations are available for qualified individuals with disabilities upon request. This role defines success by achieving essential function outcomes, not by the method of completion. 
Compliance Statement 
This job will be performed consistent with ADA, FMLA, FLSA, and other applicable federal, state, and local laws regulating employment</div>
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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business. 
 
For applicants in California, please review our California Consumer Privacy Statement here. https://www.gohealthuc.com/privacy-policy</div>

Patient Account Specialist

CHRISTUS Health

<div>Description 
Summary:
Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution and includes communication with patients, clients, reimbursement vendors, and other external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction is essential. Associates in the collection units are expected to have knowledge of the overall collection work processes for both active AR and BD inventory.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA&rsquo;s business objectives.</li><li>
Documents and updates patient account information in TLRA&rsquo;s collection software system timely and accurate to include appropriate account status.</li><li>
Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and requests.</li><li>
Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.</li><li>
Performs research and analysis of account issues and strives to resolve problems timely and accurately.</li><li>
Ensure daily productivity standards are met.</li><li>
Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.</li><li>
Must have solid knowledge and utilization of desktop applications to include Word and Excel are essential.</li><li>
General hospital A/R accounts knowledge is required.</li><li>
Performs other special projects as required when assigned.</li></ul>
Collections &ndash; Insurance
<ul><li>Maintains active knowledge of all collection requirements by payors.</li><li>
Collects balance owing from third-party payers in accordance with State and Federal laws governing collections practices. Ensures that collection efforts are thorough with the overall objective being to collect outstanding balances in an ethical manner.</li><li>
Ensures quality standards are met and proper documentation regarding patient accounting records.</li><li>
Contact other departments to obtain necessary information for appeals, pending information, and any other issues that impact and/or delay claim processing.</li></ul>
Collections &ndash; Self Pay
<ul><li>Ensures that self-pay accounts are handled in a customer service-oriented manner that accomplishes the goal of collecting monies due to clients, while at the same time preserving the positive image of TLRA that exists in the community.</li><li>
Responsible for assisting patients in identifying eligible means of financial assistance or if non apply working with the patient to make acceptable payment arrangements.</li><li>
Must be an effective team member with good communication skills. Must participate in team meetings, communicate work-related ideas and concerns proactively, and assist in finding appropriate resolutions.</li></ul>
Physician Billing/Collections
<ul><li>Ensure proper reimbursement for all services and to ensure all appeals are filed timely.</li><li>
Review accounts and determine appropriate follow-up activities utilizing Six Sigma Practices.</li><li>
Identify under and overpayments and take appropriate actions to resolve accounts.</li><li>
Validate commercial insurance claims to ensure the claims are paid according to the contract.</li><li>
Direct knowledge using Meditech and CollectLogix software.</li><li>
Monitor and communicate errors generated by other groups and evaluate for trends.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>High School diploma or equivalent years of experience required.
</li></ul>Experience
<ul><li>3-5 years of experience preferred.
</li><li>experience in a Customer Service call center environment with a focus on healthcare billing/collections or collection agency environment required.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul>
Work Type: 
Full Time
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We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925.</div>

Patient Account Specialist Senior - TLRA Insurance

<div>Description 
Summary:
Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution and includes communication with patients, clients, reimbursement vendors, and other external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction is essential. Associates in the collection units are expected to have knowledge of the overall collection work processes for both active AR and BD inventory.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA&rsquo;s business objectives.</li><li>
Documents and updates patient account information in TLRA&rsquo;s collection software system timely and accurate to include appropriate account status.</li><li>
Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and requests.</li><li>
Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.</li><li>
Performs research and analysis of account issues and strives to resolve problems timely and accurately.</li><li>
Ensure daily productivity standards are met.</li><li>
Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.</li><li>
Must have solid knowledge and utilization of desktop applications to include Word and Excel are essential.</li><li>
General hospital A/R accounts knowledge is required.</li><li>
Performs other special projects as required when assigned.</li></ul>
Collections &ndash; Insurance
<ul><li>Maintains active knowledge of all collection requirements by payors.</li><li>
Collects balance owing from third-party payers in accordance with State and Federal laws governing collections practices. Ensures that collection efforts are thorough with the overall objective being to collect outstanding balances in an ethical manner.</li><li>
Ensures quality standards are met and proper documentation regarding patient accounting records.</li><li>
Contact other departments to obtain necessary information for appeals, pending information, and any other issues that impact and/or delay claim processing.</li></ul>
Collections &ndash; Self Pay
<ul><li>Ensures that self-pay accounts are handled in a customer service-oriented manner that accomplishes the goal of collecting monies due to clients, while at the same time preserving the positive image of TLRA that exists in the community.</li><li>
Responsible for assisting patients in identifying eligible means of financial assistance or if non apply working with the patient to make acceptable payment arrangements.</li><li>
Must be an effective team member with good communication skills. Must participate in team meetings, communicate work-related ideas and concerns proactively, and assist in finding appropriate resolutions.</li></ul>
Physician Billing/Collections
<ul><li>Ensure proper reimbursement for all services and to ensure all appeals are filed timely.</li><li>
Review accounts and determine appropriate follow-up activities utilizing Six Sigma Practices.</li><li>
Identify under and overpayments and take appropriate actions to resolve accounts.</li><li>
Validate commercial insurance claims to ensure the claims are paid according to the contract.</li><li>
Direct knowledge using Meditech and CollectLogix software.</li><li>
Monitor and communicate errors generated by other groups and evaluate for trends.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>High School diploma or equivalent years of experience required.
</li></ul>Experience
<ul><li>3-5 years of experience preferred.
</li><li>experience in a Customer Service call center environment with a focus on healthcare billing/collections or collection agency environment required.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 
Work Schedule: 
5 Days - 8 Hours
Work Type: 
Full Time</div>

<div>Description 
Summary:
Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution and includes communication with patients, clients, reimbursement vendors, and other external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction is essential. Associates in the collection units are expected to have knowledge of the overall collection work processes for both active AR and BD inventory.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA&rsquo;s business objectives.</li><li>
Documents and updates patient account information in TLRA&rsquo;s collection software system timely and accurate to include appropriate account status.</li><li>
Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and requests.</li><li>
Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.</li><li>
Performs research and analysis of account issues and strives to resolve problems timely and accurately.</li><li>
Ensure daily productivity standards are met.</li><li>
Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.</li><li>
Must have solid knowledge and utilization of desktop applications to include Word and Excel are essential.</li><li>
General hospital A/R accounts knowledge is required.</li><li>
Performs other special projects as required when assigned.</li></ul>
Collections &ndash; Insurance
<ul><li>Maintains active knowledge of all collection requirements by payors.</li><li>
Collects balance owing from third-party payers in accordance with State and Federal laws governing collections practices. Ensures that collection efforts are thorough with the overall objective being to collect outstanding balances in an ethical manner.</li><li>
Ensures quality standards are met and proper documentation regarding patient accounting records.</li><li>
Contact other departments to obtain necessary information for appeals, pending information, and any other issues that impact and/or delay claim processing.</li></ul>
Collections &ndash; Self Pay
<ul><li>Ensures that self-pay accounts are handled in a customer service-oriented manner that accomplishes the goal of collecting monies due to clients, while at the same time preserving the positive image of TLRA that exists in the community.</li><li>
Responsible for assisting patients in identifying eligible means of financial assistance or if non apply working with the patient to make acceptable payment arrangements.</li><li>
Must be an effective team member with good communication skills. Must participate in team meetings, communicate work-related ideas and concerns proactively, and assist in finding appropriate resolutions.</li></ul>
Physician Billing/Collections
<ul><li>Ensure proper reimbursement for all services and to ensure all appeals are filed timely.</li><li>
Review accounts and determine appropriate follow-up activities utilizing Six Sigma Practices.</li><li>
Identify under and overpayments and take appropriate actions to resolve accounts.</li><li>
Validate commercial insurance claims to ensure the claims are paid according to the contract.</li><li>
Direct knowledge using Meditech and CollectLogix software.</li><li>
Monitor and communicate errors generated by other groups and evaluate for trends.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>High School diploma or equivalent years of experience required.
</li></ul>Experience
<ul><li>3-5 years of experience preferred.
</li><li>experience in a Customer Service call center environment with a focus on healthcare billing/collections or collection agency environment required.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 
Work Schedule: 
8AM - 5PM Monday-Friday
Work Type: 
Full Time</div>

Patient Account Specialist Senior - TLRA Support Services

University of Texas Medical Branch

<div>EDUCATION &amp; EXPERIENCE:
Minimum Qualifications:<ul><li>
Two years of financial experience or one year of patient accounts experience.
</li></ul>JOB SUMMARY:
The Patient Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to ensure timely and appropriate reimbursement and account resolution.
ESSENTIAL JOB FUNCTIONS:<ul><li>
Demonstrates a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines</li><li>
Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements</li><li>
Billing payers and/or clients for hospital and/or Professional Patient Accounts</li><li>
Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims</li><li>
Performs online corrections to edited claims according to procedures</li><li>
Performs detailed follow-up activities on assigned accounts according to procedures</li><li>
Responds to daily correspondence according to procedures</li><li>
Identifies denials and underpayments for appeal</li><li>
Reviews, researches, and processes denied claims</li><li>
Appeal claims as appropriate according to policies and procedures</li><li>
Updates account information and documents as appropriate within Epic Resolute</li><li>
Processes account adjustments according to policies/procedures</li><li>
Issues payer and/or patient refunds according to policies/procedures</li><li>
Validates accuracy of payments and/or adjustments on accounts</li><li>
Resolves outstanding accounts at required accuracy and productivity requirements</li><li>
Maintains comprehensive knowledge of the work unit assigned</li><li>
Assists in the development of department policies and procedures</li><li>
Adheres to established policies and procedures</li><li>
Adheres to internal controls and reporting structure</li><li>
Maintains open and professional communication with customers, colleagues, and vendors</li><li>
Performs well in a team environment</li></ul>
Marginal or Periodic Functions:<ul><li>
Successfully completes competency-based training and testing</li><li>
Prioritizes and completes all work in an accurate, effective, and efficient manner</li><li>
Participates in team meetings/activities and supports the philosophy and goals of the team and department</li><li>
Assists in the training and mentoring of new employees</li><li>
Reads all announcements and relevant communications relating to job duties</li><li>
Performs related duties as required.</li></ul>
WORKING ENVIRONMENT/EQUIPMENT:<ul><li>
Standard hospital, clinical, laboratory and/or office environments.</li><li>
Standard office equipment.</li></ul>
SALARY RANGE:
Actual salary commensurate with experience.
WORK SCHEDULE:
On-site, Monday through Friday, 8 AM - 5 PM. 
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.</div>

Patient Account Specialist - Revenue Cycle HB Billing & Denials

Presbyterian Healthcare Services

<div>Location Address:
9521 San Mateo NE Albuquerque, NM 87113-2237

Compensation Pay Range:
Minimum Offer $15.60 Maximum Offer $22.12 Now Hiring: Patient Access Account Specialist I-ABQ
Summary:
Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist I provides basic functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Performs basic financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, and pre-service collections. The Patient Access Account Specialist I will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. The Patient Access Account Specialist I must possess a basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access to include HIPAA, EMTALA, and CMS guidelines of MSPQ. The Patient Access Account Specialist (PAAS I) monitors work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured and there is a clean claim for billing. The Patient Access Account Specialist I acts as resource to all employees within Patient Access. The Patient Access Account Specialist I is responsible for providing the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. The PAAS I will work with ancillary departments to ensure the procedures scheduled and authorized meet payer requirements. The Patient Access Account Specialist I provides coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Type of Opportunity: Full time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)

Responsibilities:
Customer Service and Caring Practices: *Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools. *Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes. *Ability to manage conflict and appropriately request the help of a supervisor when needed. *Implement PROMISE and CARES behaviors in every encounter. *Educates patients for whom they speak regarding insurance benefits and liabilities. *Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters Encounter Components: *Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to; *Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts. *Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge. *Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account. *Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly. *Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines. *Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service. *Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail. *Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a proficient knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements *Ensure accurate completion of MSPQ prior to date of service. *Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate. *Monitor and track Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary. *Maintain appropriate records, files, and timely and accurate documentation in the system of record. *Work with ancillary departments to ensure coding, diagnosis and facility are authorization are in alignment. *Work with payers to ensure authorization is in place; initiating the auth when appropriate. *Coordinate efforts with Financial Advocates to secure payer source current and future visits. *Monitor work queues to identify late add-on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures from being performed. *Work with physician offices to resolve discrepancies in authorizations and scheduled procedures. Financial Accountabilities: *Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient prior to visit or make arrangements for payment at time of service. *Ensure a payer source has been identified prior to services being rendered. *Ensure authorization for correct procedure (CPT), facility, and date of service is obtained. Patient Relations *Contact patients pre-visit to complete any information missing from the account to ensure accuracy prior to visit. *Transparency with patients through communication of patient liabilities and authorization issue in a timely manner, allowing patients ability to make informed decisions. *Educate patients and answer questions from patients on benefits, liabilities and financial options. *Provide patient with way-finding for appointment at time of pre-registration. *Perform AIDET when speaking to patient to alleviate anxiety and confusion. Quality Improvement: *Perform assigned patient care responsibilities, which may include but not limited to: *Cooperate fully in all risk management activities and investigations. *Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation. *Conduct all transactions in compliance with all company policies, procedures, standards, and practices. *Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position. C.A.R.E.S Behaviors: *Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter. *Other duties as assigned
Qualifications:
*High school diploma, continued education preferred *External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher *Previous completion and passing of Patient Access Advocate II and III Advancement test. *A minimum of 2 years of work experiences in healthcare setting within Patient Access and/or billing plus strong customer service background. *Strong knowledge and understanding of insurance and financial processing of accounts. *Proficient in EPIC ADT system *Specialty Certifications: CHAA, CHAM or other industry equivalent certification preferred *Pass annual competency exam for all areas of responsibility. *Requires general knowledge of the customer encounter process which may include registration, contract requirements, and coordination of benefits. *Knowledge in Microsoft Office Products. *Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation. *Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class. UPDATED 7/29/25
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. 
Wellness 
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. 
Why work at Presbyterian? 
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. 
About Presbyterian Healthcare Services 
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.<h1 class="jobSectionHeader">
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services</h1></div>

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