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Full-timeDescription
POSITION SUMMARY:
The Payment Reconciliation Specialist will be responsible for following up on outstanding claims for assigned clients and ensuring that Accuity and select healthcare facilities receive the accurate reimbursement for services rendered. The Payment Reconciliation Specialist will be responsible for tracking patient accounts, reviewing insurance claims, and communicating with various stakeholders, including Accuity leadership, client finance and billing staff, and others.
PRIMARY JOB RESPONSIBILITIES:
- Follow up on outstanding claims and appeals to ensure timely and accurate reimbursement
- Manage patient accounts, including tracking payments, adjustments, and refunds as well as reporting out any differences between what was expected
- Review insurance claims and ensure that all billing requirements are met
- Communicate with specific individuals internally and externally to ensure that claims are processed accurately and efficiently
- Monitor accounts receivable and identify trends and patterns that may impact revenue
- Perform data entry and update patient information in the select systems
- Maintain accurate records of all billing and collection activities
- Maintains an up-to-date working knowledge of MS-DRG, APR-DRG, ICD-10 CM/PCS Coding Clinics
- Verifies that payments received are correct and according to company’s fee schedules, and that claims are processed correctly against billing and industry standards and regulations and match client contract agreements
- Ensures posting accuracy through careful review of electronic remittance advices (ERA)
- Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate review results/findings and correct, as necessary
- Abstracting and performing a comprehensive review of the medical record to assess the documentation present/absent as it compares to the base code set impacting payment, or a requested query or change in coding
- Review scope includes validation of the MS-DRGs and APR-DRGs assigned for Medicare, Medicaid, commercial, and third-party claims
- Develops and maintains a strong understanding of Accuity and of client specific technology, policy, procedures, guidelines, and workflows
- Tracks and trends billing statuses, final outcomes, and reports this information in a clear and concise manner to the VP of Client Operations and other stakeholders
- Provides feedback to Accuity teams and team leaders on specific encounter outcomes as well as any overall trended opportunities
- Ensures strict confidentiality of patient information
- Accountable for meeting or exceeding both production and quality expectations
- Meets or exceeds short-term and long-term goals as established for the department
- May require schedule flexibility and change to accommodate workflow
- Participates in staff meetings and attends other meetings and seminars as required
- Assist in special projects and other roles and responsibilities as needed to support Accuity
- Performs miscellaneous job-related duties as assigned
Requirements
POSITION QUALIFICATIONS:
Education
:
- High school diploma or GED required
- Associate's or Bachelor's degree in Healthcare Administration or related field preferred
Experience:
- Minimum of 3+ years of experience in healthcare billing and collections
- Minimum of 3+ years of experience with generic accounting, transactions, or medical billing systems (preferred)
- Knowledge of medical billing codes, insurance policies, and reimbursement procedures
- Excellent communication skills, both verbal and written
- Strong attention to detail and ability to prioritize tasks
- Advanced proficiency in Microsoft Office Suite (Excel) required
- Experience with PBAR, ACE, and/or FinThrive applications (preferred)
- Ability to work independently and as part of a team
- Knowledge of HIPAA regulations and compliance requirements
Licensure and/or Credentials:
- HFMA (Healthcare Financial Management Association) certified
- CRCR (Certified Revenue Cycle Representative) certification preferred
Knowledge, Skills, and Abilities:
- Expert knowledge of Healthcare Revenue Cycle processes, specifically inpatient (IP) billing, rebilling, denials, and overall account adjudication processes and standards
- Understanding of Official Coding Guidelines, advanced knowledge of APR and MS DRG reimbursement models, state, and federal regulations
- Maintains familiarity with related criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies to include POA assignment and discharge disposition codes
- Demonstrated knowledge of Coding Clinics as they relate to current IP coding practices
- Advanced knowledge of medical coding, electronic medical record systems, and coding systems
- Knowledge of quality assurance concepts and principles
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
- Ability to use independent judgment and to manage confidential information
- Ability to analyze and problem solve
- Detail oriented with ability to multi-task
- Strong communication (written and oral) and interpersonal skills
- Ability to use a PC in a Windows environment, including MS Word, Excel, etc.
- Able to execute under the pressure of time constraints and maintain focus over period of work hours
- Demonstrates ability to work independently as well as cooperatively with various teams
- Serves as a professional role model for internal and external customers
