Patient Accounts Specialist - Insurance (Appeals/Denials) Job Listing at Emerus Holdings Inc. in Houston, TX (Job ID 2024-18199)

Description

The purpose of this position is to assist in managing the company's outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.  

• High School Diploma or GED, required
• 2+ years experience in a provider setting (inpatient or outpatient), required
• Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws, required
• Knowledge and understanding of healthcare ‘explanation of benefits' (EOB's), required
• Experience with a 10-key adding machine, required

• Position requires fluency in English; written and oral communication

• Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Manage claim details and verify accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes 
• File appeals for denied claims and follow-up as necessary through appeal resolution
• Manage and maintain outstanding patient balances to ensure accurate reporting of company's accounts receivable
• Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
• Submit refund requests as necessary
• Works special projects as assigned by Supervisor/Director/CFO

• Meet position's goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned
• Willingness and ability to work overtime