Account Specialist

Position Summary:  The Account Specialists are divided into segments by class code with an Account Specialist assigned to each segment.  Once a fee ticket is entered into the computer system, it is the Account Specialist’s responsibility until the bill is a zero balance. This individual must be flexible due to the constantly changing insurance carrier rules/requirements as well as have knowledge of same.  Skills are analytical and accounting type in nature, i.e., assessing debits and credits, with the ability to communicate well with the patients and the insurance carriers.   Work is performed under the general direction of the Revenue Cycle Supervisor.

Essential Duties and Responsibilities:

• Assesses proper payments and adjustments on individual bills or an entire patient account for accuracy of processing and take the appropriate action if done incorrectly-overpayments, underpayments, and no payments.
• Resolves billing issues/questions from both insurance carriers and patients by phone, fax, or mail.
• Processes mail daily that has been received from insurance carriers and patients, our data entry-whether charge errors or payment discrepancies, and other miscellaneous correspondence.
• Processes credit balances according to The West Clinic, P.C. procedure “How to Handle Credit Balances.”
• Selects and photocopies various medical records as documentation, compendium information, drug inserts, etc., in order to facilitate reimbursement from pre-payment reviews or appeals of denied claims.
• Interfaces with Coding, Medical Records, and Patient Representatives verifying coding if claims denied, using charts for audit and/or verification purposes and resolving insurance issues and referral pre-certs. Also interfaces with Insurance companies and patients regarding billing and reimbursement issues and answering questions/explanation of bills.
• Respects the dignity and confidentiality of patients.
• Maintains a good attendance record and report on time for work.
• Maintains a professional attitude and appearance.
• Complies with clinic safety policy and procedures.
• Possesses good communication skills that lend to a team oriented work environment.
• Attends staff meetings as scheduled.
• Assists with training and orientation of new employees as assigned.
• Performs other duties as assigned.

Qualifications/Experience:

Associate’s degree or equivalent from two-year college or technical school; or two to three years’ related experience and/or training; or equivalent combination of education and experience – Level II equals 3+ yrs exp & level III equals 5+ yrs experience.

Must have excellent organization and follow-up skills; excellent verbal and written communication skills; excellent problem-solving skills; ability to organize and prioritize work assignments; ability to handle multiple priorities in a fast-paced environment; ability to analyze situations and respond in a timely manner; ability to participate in multi-functional teams; ability to establish and maintain effective working relationships within The West Clinic. Must be proficient in computer applications including word processing and e-mail with the ability to perform 10 key by touch.  Additional hours may be required.

Work Environment/Physical Demands/Travel:

• Typical clinical environment with moderate noise level.
• Ability to stand, walk, sit and use hand/wrist, talk, hear, see, and stoop or crouch for extended periods of time.
• Ability to read and understand documents such as safety rules, operating and maintenance instructions, procedure manuals, correspondence. Ability to write routine reports and correspondence.  Ability to speak and present information in small groups of customers, suppliers, or employees of the company.
• Ability to calculate figures and amounts such as discounts, interest, commissions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
• Ability to apply common sense understanding to carry out instructions given in written, oral, or diagram form. Ability to deal with problems involving a few concrete variables in routine situations.
• Ability to lift up to 25 lbs.
• Some travel may be required.