Job description
PATIENT ACCOUNTS SPECIALIST
HEALTH DEPARTMENT
SALARY $29,708-$46,048 (Depending on Qualifications)
$14.28-$22.14/Hour
GENERAL STATEMENT OF DUTIES
The overall primary purpose and objective of this position is to maintain an accurate computerized patient accounts receivable system. This involves setting up accounts, collecting, and posting payments for the Medicare and Private Insurance Patients of the Caldwell County Health Department Lenoir Clinic site. This position requires an extensive knowledge of Medicare, Medicaid, and private insurance rules and regulations in order to remain in compliance.
Public Health is a first responder agency for natural disasters (e.g. hurricanes, tornadoes, floods, winter storms), naturally occurring infectious disease outbreaks (e.g. influenza, SARS), technological hazards (hazardous materials releases, critical infrastructure disruptions), and terrorist incidents. This position, like all other positions within the Department may be required to participate in any emergency response activities as deemed necessary by the Health Director or his/her designee. Availability during emergencies and exercises is required.
EXAMPLES OF DUTIES PERFORMED
- Handles all inquiries regarding patient accounts dealing with Medicare or Private Insurance. Relates necessary financial information regarding the sliding fee scale, fees for services, etc.
- Reviews all insurance benefits, collects co-payments, and patient payments etc.
- Works closely with medical director, examiners, RN’s and Administrative Officer in the clinic setting to ensure that the correct charges/CPT and diagnosis codes have been indicated for Medicaid, Medicare, insurance and private pay patients.
- Assesses the financial eligibility of clinic patients by collecting the necessary information to determine the financial eligibility of the patient and/or patients’ family. Obtains documentation of income, third party payer information, and/or private insurance, and total number in the household. Analyzes the patient’s financial information and determines if the patient qualifies for a reduced fee for service (sliding fee scale).
- Itemizes each service rendered to the patient, which is indicated on an encounter form, and enters information to the patient’s individual computerized ledger.
- Corresponds with other agencies, facilities, i.e., Dept. of Social Services, physician’s offices, school system, and industries regarding financial information.
- Has frequent contact with third-party payers and staff regarding services available/billable and answers questions regarding eligibility and charges.
- Generates a cash drawer report daily – cash received daily and payments by mail. Payments come from individual patients, agencies, insurance companies, etc.
- Remittance advises are posted to individual computer ledger to show payments, adjustments or denials. Adjustment to payer source is determined and appropriate transfer is made.
- Reviews pending claims files monthly and initiates follow-up with inquiries or resubmits as appropriate if claims remain unpaid.
- Maintains monthly billing commercial claims and Medicare claims for pending and processed claims.
- Must possess considerable knowledge of the agency’s policy and procedures concerning billing and collecting. Must be able to explain billing/fees for service to patients.
- Has complete knowledge of Medicare and insurance billing procedures.
- Assists with answering incoming phone calls and making appointments
- Position will be cross-trained to perform other duties related to the program area.
Filing and Posting Insurance Claims/Medicare/Private Billing and Other Support Activities:
Posts procedures, payer, quantity, provider, payment, and other data required by the agency from the encounter form to individual patient computer ledger. Determination of payer is made upon interview with patient and completion or update of financial eligibility. Encounter forms are batched daily with missing encounters accounted for and distributed to appropriate staff as needed for further processing.
Recruitment Standards
Completion of high school and a minimum of 2 years experience, preferably in billing insurance, Medicaid and Medicare claims.
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