Patient Account Specialist

ABOUT AUSTIN REGIONAL CLINIC:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years! We are one of central Texas’ largest professional medical groups with 25+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE
Assists incoming callers/patients with billing inquires, by collecting all insurance and demographic information necessary to appropriately setup a patient account, while providing excellent customer service. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS
Customer Service

• Receives inbound telephone calls from internal and external customers. ie. Patients, Insurance Representatives.
• Asks appropriate verification questions prior to releasing confidential patient information in accordance to company policy/HIPAA guidelines.
• Reviews explanation of benefits documents with knowledge and ability to explain information to patients/customers.
• Provides financial counseling service/payment arrangements to walk-in patients with outstanding account balances.
• Maintains and follows up on work queue accounts in a timely manner and documents all actions with clear and accurate documentation.
• Receives patient refund request information and forwards to Refunds processing.
• Requests information on patient charges from Clinics and Coding Quality and follows up in a timely manner.
• Returns telephone calls to follow up with patients on status or outcome of their inquiry within the timeframes established by the department.
• Answers patient registration phone calls.
• Obtains all insurance and demographic information from patient necessary to setup accounts.
• Verifies insurance coverage and sets up new members for all insurance contracts.
• Updates insurance and demographic information on existing patients as provided by patient call or additional information received from site resources.

Job Description

• Runs registration reports and follows up on incomplete or missing account information as indicated to complete registration process.
• Researches member account transactions for eligibility inconsistencies.
• Maintains complete, accessible, dated files and resource materials.
• Provides assistance to coworkers as requested and/or necessary.
• Documents productivity statistics reports to CBO Supervisor.
• Maintains thorough and effective communication with all coworkers.
• Utilizes Payor website systems and tools to accurately complete registration process.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Works holiday shift(s) as required by Company policy
• Account Transactions/Insurance
• Reviews account transactions for accuracy, and distributes patient credits.
• Uses appropriate transaction and ANSI codes per posting guidelines.
• Reviews and documents patient correspondence. Contacts patients to acknowledge receipts of correspondence in a timely manner, whenever necessary.
• Obtains updated insurance information, verifies and enters coverage and retro-adjudicates claims accordingly.
• Follows up with insurance carriers on payments and adjustments in order to resolve patient issue. Refers accounts to the Appeals department, if applicable.
• Reviews automated claim form and edits as necessary to reflect complete, accurate information.
• Utilize Payor websites efficiently and maintain confidential security passwords.
  Collections
• Receives credit card payments via telephone processes payments over the secured online portal.
• Establishes payment plans per Payment Agreement guidelines.
• Works closely with Collections department, collecting agencies, and/or directly with patients on payment of balances due.
• Sets up accounts with payment plan information in EPIC and the online bill pay tool, and clearly documents the terms of the agreement in EPIC.
• Consults with CBO Supervisor prior to offering discounts for non-covered services.
• Return telephone calls to follow up with patients on status of their inquiry within timeframes established by department.

OTHER DUTIES AND RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS
Education and Experience
Required: High school diploma or GED. Experience with admitting/registration, insurance claims, or related customer service.
Preferred: One (1) or more years of medical billing customer service experience.

Knowledge, Skills and Abilities

• Must successfully complete the Patient Accounts Specialist II Skills Assessment Test.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent verbal and written communication skills.
• Knowledge of and/or experience with CPT and ICD-9 coding.
• Knowledge of legislative and private sector third party regulations and guidelines.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Certificate/License: None

Schedule: On an as needed basis.