Patient Accounts Specialist

Perform duties in the billing division related to all aspects of the revenue cycle to include data entry, denials, patient interaction, patient account research, and insurance follow-up and extracting appropriate CPT and ICD-10 codes.

Review H&P and surgeon's documentation for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• Analyzes medical records and identifies documentation deficiencies.
• Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies that documentation supports diagnoses, procedures and treatment results.
• Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
• Follows coding conventions. Serves as coding consultant to care providers.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Assists in orienting and training staff.
• Provides ongoing training to staff as needed.
• Create charge encounters by entering CPT and ICD10 codes in the Electronic Health Record (EHR) system.
• Research and resolve insurance denials

• Process - posting claims and manage/work rejections
• Review claim and discuss overdue balance with patients.
• Register and Update patient demographics in IDX
• Calculate patient deductibles and co-insurance payment amount
• Develop payment plans and make payment arrangements for outstanding balances
• Assists patients/customers with insurance information and balances

• Handles special projects as requested

• Ensures doctor(s) submit notes in a timely manner in order to process claims efficiently.
• Verifies insurance information by calling carrier if applicable.
• Responds to inquiries from patients and researches accounts.
• Must possess the ability and skill to independently work in a team environment.
• Performs other duties as assigned.

1 year experience working with CPT & ICD 10 coding and billing required. Current CPC certification is required, or must obtain within 1 year of employment.

Medical applications software experience, Allscripts/IDX preferred. Experience with linking ICD10 to CPT codes to support medical necessity. Knowledge of payor guidelines. Experienced with using modifiers. Ability to extract a written diagnosis from the medical record to assign an ICD10 code.