Patient Account Specialist II
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Job Profile Summary
This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.
Job Overview
This position is responsible for accurate and timely posting of cash payments and rejection messages to patients accounts along with timely and correct reconciliation adhering to established policies, protocols and procedures.
Job Description
Minimum Qualifications:
1. High school diploma or equivalent.
2. Two (2) year of experience in an automated medical billing and collection environment for a medical services provider and/or third-party payer.
Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
1. Separates cash items from either lockbox or mail and prepares for posting.
2. Compute remits, when necessary, and post cash payments to patient’s accounts quickly and accurately as per procedure, balancing to control totals.
3. Review, prioritize, research and resolve holding accounts in a timely and accurate manner.
4. Follows up on all outstanding or incorrectly paid or rejected claims by utilizing the required reports. Involves telephoning and/or rebilling the claims.
5. Identifies problems and discrepancies within the system, payer payment or policies and brings them to the supervisor’s attention.
6. Identify uncollectible accounts and write off to the appropriate write off code in a timely manner.
7. Determines transactions and enters into GL either manually or through system access.
8. Downloads, posts and balances electronic remit advices accurately and timely.
9. Corrects and resubmits all accounts rejected during the download process.
10. Processes specific correspondence and telephone calls relating to follow up, adding new/corrected insurance information. Edits accounts where necessary and bills/re-bills.
11. Verifies services with appropriate ancillary department when necessary.
12. Takes the initiative to meet the customers’ needs and solve customers’ problems, or finds someone who can.
13. Treats others with dignity, respect and compassion. Respects privacy of information and exercises good judgment about the dissemination of confidential information.
14. Organizes and prioritizes responsibilities to complete work assignments; completing priority assignments promptly.
Physical Requirements:
1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.
2. Frequently required to speak, hear, communicate and exchange information
3. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols
4. Occasionally lift and/or move up to 25 pounds
Skills & Abilities:
1. Excellent communication skills and the ability to effectively communicate with all areas of Patient Financial Services as well as Revenue Cycle.
2. Excellent interpersonal skills with the ability to react in a professional manner. Excellent interpersonal and communication skills and a basic understanding of team management concepts.
3. Ability to work independently and as part of a team in a fast-paced environment to satisfy the needs to support all areas of Patient Financial Services.
4. Maintains current knowledge of rules and regulations governing third party payers and working knowledge of various billing tasks.
5. Ability to use computerized billing and A/R systems and various PC based programs (Excel, MS Word)
6. Organizational and time management skills in order to complete tasks within a specified time.
7. Ability to develop and maintain professional, service-oriented working relationships with leadership, patients, and co-workers.
8. Ability to work independently or in a team environment.
9. Attention to detail to ensure a must to ensure correspondence is distributed to appropriate areas of Revenue Cycle.
10. Ability to learn PC based computer systems, word processing, database and spreadsheet software programs. Proficient in using computers and navigating through third party application systems and web portals efficiently and effectively.
Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.
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