Patient Account Representative

Tenet Healthcare; Marietta (GA); On-site; USD 55,000 - 75,000; Full time

Job summary

Tenet Healthcare in Marietta, GA is seeking an experienced Ophthalmology-focused coding and accounts receivable professional to perform coding, posting, claims resolution, and benefits coordination within the patient financial services department.

The role emphasizes analyzing insurance payments, adjudicating denials, and ensuring proper documentation and coordination of care across payors. Strong attention to detail and knowledge of ICD-10-CM, CPT, HCPCS are required.

Qualifications

• General Minimum Education and Background Requirements: High school diploma or GED.
• Healthcare Experience preferred.
• Coding: CCS, CCS-P or CPC certified or certification in process, 4+ years Ophthalmology experience
• Posting: College Degree or High School Diploma, 4+ years Ophthalmology experience, Experience with managed care contracts, Payment posting experience is preferred
• Claims Resolution: CPC certified or certification in process, Medical Practice experience 2+ years
• Benefit Coordination: Minimum of one year experience in a hospital admitting/registration practices insurance and managed care areas

Responsibilities

• Reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments
• Perform ICD-10-CM, CPT and HCPCS coding for reimbursement
• Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
• Assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented information.
• Abstracts all necessary information and assigns codes (ICD-10, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
• Edits (claim scrubbing)
• Charge entry, assignment of ICD-10 code (reasonability, validity)
• Electronic claim submission and rejection follow up
• Co-managed Surgery coordination and reporting
• Independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion.
• Accurately post or record information regarding collection receipts.
• Processes and files information regarding collection receipts.
• Quick evaluation and detail oriented.
• Research oriented and capable.
• Files correspondence, records, and reports.
• Bank and Bank Partner liaison
• Bank Deposit reporting and balancing
• 835 file management, deposit tracking
• Timely application of payments and denials
• Co-managed Surgery coordination and reporting
• Reviews reports to ensure timely follow-up and resolution of accounts for assigned payors.
• On a daily basis, researches and corrects denials received for assigned clients.
• Documents all correspondence with patients, insurance carriers and clients.
• Receives payments from patients via phone or in-person.
• Responds to requests for information from patients, insurance carriers and clients within 2 business days.
• The claims resolution function/position is responsible for following-up and resolving all unpaid insurance claims for assigned payors.
• Working Clearwave system to accurately display correct insurance for claim filing
• To ensure all services for MEC have appropriate insurance benefit coverage as well as authorization and notification in place prior to all outpatient elective on-elective scheduled services and within contractual guidelines for urgent and emergent services.
• Responsible for completing work lists timely.

Skills

Healthcare experience

Education

CCS, CCS-P or CPC certified

Ophthalmology experience 4+ years

College Degree or High School Diploma

Job description

Job Summary

Summary of Responsibilities: The person in this role may act in either all, one, or some of the following functionalities: Coding, Posting, Claim Resolution, or Benefits Coordination. All functions perform highly technical and specialized functions for the patient financial services department. Persons in this role may be responsible for assisting in new hire training. The person in this role must maintain patient confidentiality and adhere to all policies and procedures as outlined in Employee Handbook or departmental guidelines. Must adhere to work schedule as well as time and attendance policies - variable work schedules 7:00 am until 6:30 pm Monday through Friday. These hours can/ may change based upon department needs. Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

Responsibilities

Coding:

• Reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments
• Perform ICD-10-CM, CPT and HCPCS coding for reimbursement
• Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
• Assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the physician are valid and complete. .
• Abstracts all necessary information and assigns codes (ICD-10, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Promotes positive customer relations for the Marietta Eye Clinic.
• Edits (claim scrubbing)
• Charge entry, assignment of ICD-10 code (reasonability, validity)
• Electronic claim submission and rejection follow up
• Co-managed Surgery coordination and reporting

Posting:

• Independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion.
• Accurately post or record information regarding collection receipts.
• Processes and files information regarding collection receipts.
• Quick evaluation and detail oriented.
• Research oriented and capable.
• Files correspondence, records, and reports.
• Bank and Bank Partner liaison
• Bank Deposit reporting and balancing
• 835 file management, deposit tracking
• Timely application of payments and denials
• Co-managed Surgery coordination and reporting

Claims Resolution:

• Reviews reports (aged trial balance, aging reports, etc.) to ensure timely follow-up and resolution of accounts for assigned payors.
• On a daily basis, researches and corrects denials received for assigned clients.
• Documents all correspondence with patients, insurance carriers and clients.
• Receives payments from patients via phone or in-person.
• Responds to requests for information from patients, insurance carriers and clients within 2 business days.
• The claims resolution function/position is responsible for following-up and resolving all unpaid insurance claims for assigned payors.

Benefits Coordination:

• Working Clearwave system to accurately display correct insurance for claim filing
• To ensure all services for MEC have appropriate insurance benefit coverage as well as authorization and notification in place prior to all outpatient elective on-elective scheduled services and within contractual guidelines for urgent and emergent services.
• Responsible for completing work lists timely.

Qualifications

General Minimum Education and Background Requirements - specifics by function listed below:

• High school diploma or GED.
• Healthcare Experience preferred

Coding: CCS, CCS-P or CPC certified or certification in process, 4+ years Ophthalmology experience

Posting: College Degree or High School Diploma, 4+ years Ophthalmology experience, Experience with managed care contracts, Payment posting experience is preferred

Claims Resolution: CPC certified or certification in process, Medical Practice experience 2+ years

Benefit Coordination: Minimum of one year experience in a hospital admitting/registration practices insurance and managed care areas

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

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