Patient Financial Services Associate II
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Job Description
Patient financial services associate processing claims, denials, and appeals for Abbott, a global healthcare company. Resolving insurance issues and unpaid accounts through Epic and payer systems.
Responsibilities:
- Accurately and timely process claims, appeals, denials, and statements
- Resolve billing discrepancies, eligibility issues, denials, appeals, and aged unpaid claims for commercial, government, and plan coverage
- Communicate insurance information to ancillary departments and ensure appropriate coverage using Epic, external portals, and other software
- Review and resolve payor denials, appeals, and claims with no response through portals, payor calls, and system investigations
- Read and understand explanations of payments to resolve back-end claims
- Determine patient insurance eligibility, investigate accounts, and correct patient demographics, financial information, and guarantor information in Epic
- Interact with insurers and third-party payors to obtain and document authorization
- Research missing or erroneous account information using portals and other resources, including identifying unknown payors
- Review and edit claims and appeals before submission to the clearinghouse
- Analyze, research, and resolve claim issues using federal, state, and payor rules and procedures
- Correct rejected claims from the claim scrubber, clearinghouse, or payor
- Review explanations of payments and complete next steps for denials, including appeals, write-offs, or patient statements
- Investigate payor underpayments and follow up with payors by phone on unpaid aging claims
- Provide supporting documentation requested by insurance payors
- Perform accurate and timely write-offs for uncollectible accounts according to policies and guidelines
- Participate in team meetings to share denial trends and improve front-end claim edits and first-pass resolution
- Contribute workflow and best-practice ideas to improve performance, processes, and net revenue collections
- Provide ad hoc departmental support for special projects, outages, and high-volume periods
- Complete responsibilities within required timeframes while meeting quality standards
- Maintain current knowledge of medical billing regulations, rules, and guidelines
- Maintain confidentiality and comply with HIPAA guidelines and regulations
- Support the company Quality Management System policies and procedures
Requirements:
- High School Diploma or General Education Degree (GED)
- 2 years of experience in medical billing, claims, and/or insurance processing
- Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and codes
- Knowledge of medical terminology and/or health insurance terms
- Knowledge of EHR operating systems and work involving electronic records
- Proficient in computer systems and keyboarding skills
- Demonstrated strong attention to detail and focus on quality output
- Demonstrated ability to perform the Essential Duties of the position with or without accommodation
- Authorization to work in the United States without sponsorship
- Successfully complete an assessment showing understanding of Epic processes with a score of 80% or higher
- Ability to work Monday through Friday during normal business hours
- Ability to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day
- Ability to work on a computer and phone simultaneously
- Ability to use a telephone through a headset
- Preferred: Related Associate degree or medical billing certification
- Preferred: 4+ years of experience in medical or insurance billing field
- Preferred: Experience with Epic or other EHR application
Benefits:
- Reasonable accommodation available, if necessary, to assist an employee with a disability
- Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans
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