Patient Accounts Spec III

Position Summary: At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida’s east to west coasts and beyond. ORLANDO HEALTH - BENEFITS & PERKS: Forbes Recognizes Orlando Health as a Best-In-State Employer Forbes has named Orlando Health as one of America's Best-In-State Employers for 2024. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued. Employee-centric Orlando Health has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare Position Summary: The Patient Accounts Specialist III isresponsible for coordinating effortsto resolve complex accounts and ensuring representatives’ interactions with patients are consistent and compassionate during billing and follow-up activities. Thisrole is also responsible for collaborating with ancillary departments and third-party payers on efforts related to follow-up, denials, and appeals. Responsibilities: Essential Functions • Resolves inappropriate 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 billings guidelinesto determine an account’s ability to pay after initial rejection from payer • Coordinates duplicate billings, coordination of benefits, medical records or clinical resumes as needed to expedite payment of insurance claims • Identifies trends in payer non-compliance and inform management andmanaged care liaison if not able to resolve with payer • Works closely with training preceptorsin educating teammember on Mentor issues and other educational issues • Demonstrates a thorough knowledge of all third-party reimbursement requirements and/or thorough knowledge of collection agency procedures and Fair Debt Collection Practices Act (FDCPA). • Assists Patient Accounts Specialist Lead with the planning and organizing of departmental activities as needed. • Handles special projects as assigned • Analyzes claims to determine the reasonsfor discrepancies, processes denials and appeals; examines claimsto ensure payers are complying with contractual agreements. • Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner • Communicates directly with payers to follow up on outstanding claim denials, respondsto payer inquires and concerns, and works to develop and maintain positive relationships with payers. • 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, and denials. • Collaborates with payer contracting and other areas of the revenue cycle if necessary to resolve issues pertaining to a claim payment. • Helps to work and resolve accountsfrom other team members’ workloads to prevent backlogs and fillsin as needed for absent team member • 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. Other Related Functions • Participates in departmental meetings • Performs other duties as assigned Qualifications: Education/Training: • High School diploma or GED required. • Must complete Orlando Health team member development within 6months of hire date. • Works proficiently 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 II or Minimum of three (3) years’ experience in a related field (medical billing/collections/managed care). • Associate degree in Healthcare Administration, Communications, Business Finance, or related area of study may substitute for 2 years of related experience.