Reporting to the EHR/Patient Accounts Administrator and the Director of Operations, the Patient Accounts Specialist is responsible for processing Medicare, MaineCare and Commercial Insurance billing, payments and denials. This position requires overall knowledge of patient accounts, data entry and billing/receiving functions.
ESSENTIAL JOB FUNCTIONS:
Responsible for billing Medicare, MaineCare, Commercial Insurance, Consumers and other entities in accordance with established procedures.
Receives and processes insurance payments, denials and refunds.
Receives and responds to correspondence from consumers regarding billing issues and assists them with any concerns or questions regarding their bills.
Actively works aged accounts receivables.
Monitors consumer payment agreements and provides follow-up with as necessary.
Communicates with Clinical Team Lead and/or Program Manager on delinquent, active accounts over 90 days.
Sends information to designated Collection Agency on appropriate consumer accounts. Monitors payments from Collection Agency.
Provides the EHR/Patient Accounts Administrator and the Director of Operations with information on accounts needing to be written off.
Processes specialized billing for: Private Non-Medical Institutions (PNMI), Spend-Downs, and Behavioral Health Homes (BHH).
Completes end of month balancing.
Cross-trained to provide back-up for other positions within the Patient Accounts department.
OTHER DUTIES AND RESPONSIBILITIES:
Negotiates and updates contracts for commercial insurance.
Functions in a cost effective manner with regard to the utilization of time, mileage, phoning, supplies, equipment, meetings, etc.
Participates in scheduled meetings, supervisory sessions, staff meetings, and other inter-agency and intra-agency meetings as appropriate for program and position.
Seeks additional consultation and/or supervision when needed and as appropriate.
Promotes a positive agency image to staff and community.
Ensures consumer confidentiality is maintained at all times and in accordance with federal, state, and agency standards.
Completes and submits accurate time sheets according to policies and procedures.
Participates in training to maintain or enhance job skills.
Adheres to agency Risk and Safety policies and procedures.
Adheres to organizational standards for performance (see attached).
Performs other related duties, as requested.
High school diploma or equivalent with prior work experience in billing Medicare, MaineCare and Commercial Insurance.
General knowledge of billing regulations in Medicare, MaineCare, and Commercial Insurances.
Thorough knowledge of current office practices, procedures,
and equipment, including
the use of computers.
Knowledge of computer software programs, Word, Excel and Outlook.
Ability to work independently, handle multiple tasks, and meet project deadlines with a high degree of accuracy.
Strong organizational skills.
Ability to perform mathematical computations quickly and accurately.
Ability to communicate effectively both verbally and in writing to establish effective working relationships with other agency personnel.
Must have basic computer skills (see attached).
Ability to maintain confidentiality.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Normal office environment, not subject to extremes in temperature, noise, odors, etc.
May spend extended periods at terminal, on telephone, or operating other office machines, requiring eye-hand coordination and finger dexterity.
More than half of time spent in normal office setting.
*External and internal applicants, as well as position incumbents who become disabled as defined under the Americans With Disabilities Act, must be able to perform the essential job functions (as listed) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.
This job description does not constitute an employment agreement between the employer and employee, and is subject to change by the employer, as the needs of the employer and requirements of the job change.