Position Summary:

The Patient Accounts Specialist II is responsible for promoting accurate reimbursement for the organization by ensuring timely and accurate billing and collection of accounts. This individual identifies and analyzes payment variances to enact and effectively communicate corrective measures that resolve payer errors.

Responsibilities:

• Resolves inaccurate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.

• Utilizes specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account’s ability to pay after

• initial rejection from payer.

• Coordinates duplicate billings, coordination of benefits, medical records and clinical documents as needed to expedite payment of insurance claims.

• Assists Patient Accounting Rep III with the planning and organizing of departmental activities as needed.

• Analyzes underpayments and overpayments to identify root causes and examines claims to ensure payers are complying with contractual agreements.

• Collaborates with payer contracting and other areas of the revenue cycle if necessary, to resolve issues pertaining to a claim payment.

• Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquires and concerns, and works to develop and maintain positive relationships with payers.

• Helps to work and resolve accounts from other staff members’ workloads to prevent backlogs and fills in as needed for absent staff

• Assists Patient Accounting Rep III with the planning and organizing of departmental activities as needed.

• Responsible for account follow-up for all assigned accounts.

• Maintains system work queues based on electronic payers' error reports as assigned including but not limited to DNB, Claim Edits, Front End Rejections, and No Response from payers, Variances, underpayments, overpayments.

• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.

• Maintains compliance with all Orlando Health policies and procedures.

Qualifications:

Education/Training

• High School graduate or GED required.

• Must complete Orlando Health staff development within 6 months of hire date

• Works efficiently with Microsoft applications (Outlook, Word, Excel, PowerPoint)

Licensure/Certification

• HFMA Certified Revenue Cycle Representative (CRCR) certification received within six (6) months.

Experience

• One (1) year experience as a Patient Accounts Specialist I or Minimum of three (3) years’ experience in a related field (medical billing/collections/managed care).