Sr. Patient Account Specialist - Insurance

Patient Account Specialist

The purpose of this position is to assist the Patient Account Supervisor in managing the company's outstanding receivables, through routine communication with all payers to ensure that expected reimbursement for patient care is processed timely and paid accurately. This position is expected to work alongside staff as well as provide direction to less experienced staff in conjunction with the Patient Account Supervisor.

Essential Job Functions

• Assists in assigning staff workloads and shifts priorities as necessary
• Follow up on submitted claims and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Routinely communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Responsible for managing claim details and verifying accurate reimbursement, so as to initiate account adjustments and / or appeals on payment disputes
• File appeals for denied claims and follow-up as necessary through appeal resolution
• Manage and maintain outstanding patient balances to ensure accurate reporting of company's accounts receivable
• Utilize on-line / telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
• Assists in the review of refund request for accuracy and submits as necessary
• Assists in the review of adjustment requests for accuracy and submits as necessary
• Assists in the development and training of workflow process for staff and as deemed necessary for payer behavior responses
• Works special projects and provides ad hoc review of claims as assigned by Supervisor / Director / CFO
• Works closely with CBO intra departments to ensure resolution of pending claim activities.

Other Job Functions

Basic Qualifications