Patient Accounts Specialist- Insurance

Emerus Holdings, Inc.; Houston (TX); On-site; USD 42,000 - 56,000; Full time

Job summary

Emerus Holdings, Inc. seeks an Accounts Receivable Specialist in Houston to manage outstanding claims and patient balances, follow up on submissions, verify reimbursements and work with payers to resolve denials and ensure timely payment.

Ideal candidates have a High School Diploma or GED, 2+ years in a provider setting, knowledge of payors and EOBs, experience with patient accounting systems, and strong English communication with accurate 10-key skills.

Qualifications

• High school diploma or GED required.
• 2+ years experience in a provider setting required.
• Knowledge of all payors, self-pay after insurance, reimbursements and claims follow-up required.
• Experience with medical records or patient accounting systems required.
• Knowledge of state and federal payment laws and EOBs required.
• Fluency in English; strong written and oral communication required.
• Experience with a 10-key adding machine required.

Responsibilities

• Follow up on submitted claims and ensure timely reimbursement.
• Communicate with payers regarding delinquent or denied claims.
• Verify reimbursement and initiate account adjustments or appeals.
• File appeals for denied claims and follow up through resolution.
• Manage outstanding patient balances and AR reporting.
• Utilize resources to verify benefits and ensure correct claim processing.
• Submit refund requests as necessary.
• Support special projects as assigned.

Skills

Payer knowledge

Medical records systems

EOB knowledge

10-key calculator

English communication

Education

High School Diploma or GED

Job description

The purpose of this position is to assist in managing the company's outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.

Basic Qualifications

• High School Diploma or GED, required
• 2+ years experience in a provider setting (inpatient or outpatient), required
• Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws, required
• Knowledge and understanding of healthcare ‘explanation of benefits' (EOB's), required
• Experience with a 10-key adding machine, required
• Position requires fluency in English; written and oral communication

Essential Job Functions

• Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Manage claim details and verify 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
• Submit refund requests as necessary
• Works special projects as assigned by Supervisor/Director/CFO

Other Job Functions

• Meet position's goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned
• Willingness and ability to work overtime