CMC ED PFS Specialist

Overview

Job Summary

Patient Accounts Specialist (PAS) works under the immediate supervision of supervisors/managers in Patient Financial Services (PFS). PAS positions perform complex tasks requiring critical thinking skills and experience-based (specialist) knowledge in PFS. Reviews difficult work queues, large dollar accounts, aged accounts and any special projects assigned by leadership. Creates reports/spreadsheets for identification of problem areas and utilizes critical thinking skills to determine appropriate actions to resolve problem. Must demonstrate thorough knowledge and understanding of patient billing, billing transmission, government regulatory/ compliance requirements, and electronic billing systems.

Essential Functions

• Prepares reports of denials, credit balances, payer opportunities.
• Analyzes rejection reports and errors made by system and teammates. Requests system changes, reports error rates by teammate and collaborates with training to ensure improvement is achieved and sustained.
• Prepares Medicare/Medicaid quarterly credit balance reports. Approve refunds as defined in departmental threshold guidelines.
• Assists Supervisor/ Manager with quality checks for all payers and departments.
• Performs quality assurance tasks as needed to validate workflow builds, claim edit actions, automatic actions in Epic, process improvements, etc.
• Analyzes denial reasons provided by payers. Collaborates with management to identify, trend and address root causes of denials.
• Researches and analyzes payer trends and works on special projects involving aged, high dollar or complex account issues.
• Trains new teammates as needed.

Physical Requirements

Requires sitting for long periods of time. Requires bending and may need to lift-up to 10 pounds occasionally.

Education, Experience and Certifications

High school diploma or GED required. Two-years’ experience in related financial services or healthcare business office required. College (bachelor’s or associate) degree preferred. Requires the ability to communicate effectively in verbal and written formats. Proficiency in Word, Excel and Outlook preferred. Prior healthcare computer system and specifically Epic billing experience preferred.