Appeal Resolution Specialist jobs in Everett, WA

Community Health Center of Snohomish County offers competitive wages and a comprehensive benefits package designed to address health, time off, retirement and career-advancement needs.  Benefits available include health insurance (medical/dental/vision), up to 120 hours of vacation time pro-rated by FTE every 12 months, paid sick leave, 10-paid holidays, 403(b) Safe Harbor retirement plan with employer match, disability and life insurance, and more! We also offer $0.75/hour for those who test proficiently in a second language.

Job Summary

The Patient Accounts Specialist – Account Resolution is a billing and coding position that is primarily responsible for follow up operations in assigned areas of cash posting, collections, payment posting and validation, and customer service for a multi-specialty community health center.  This position requires a working knowledge of CPT, HCPC, and ICD codes as well as knowledge and experience with resolution of billing discrepancies, collection processes, and basic accounting principles.  Patient Accounts Specialists also serve as a communication link with clinical staff and are expected to communicate with them as needed while adhering to proper billing and coding guidelines.

Knowledge, Skills & Abilities

• Reads, speaks, understands and writes proficiently in English.
• Works independently and is self-directed.
• Works effectively in a team environment.
• Problem-solves with creativity and ingenuity.
• Organizes, prioritizes, and coordinates multiple activities and tasks.
• Works with initiative, energy and effectiveness in a fast-paced environment.
• Produces work in high quantity and quality.
• Remains calm and effective in high pressure and emergency situations.
• Use of multi-line telephones and other office machines.
• 10-Key: 150 kpm with a 97% accuracy rate.
• Knowledge of dental terminology.
• Knowledge of HIPAA regulations and compliance.
• Ability to make decisions regarding sensitive information.
• Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.

Preferred:

• Knowledge of dental terminology.
• Knowledge of healthcare revenue cycle functions, including documentation, coding, and billing guidelines.
• Knowledge of government rules and regulations as it pertains to compliance billing practices, using National Correct Coding Initiatives (NCCI), and third party payer rules.
• Bilingual skills.

Education

• High school graduate or equivalent.

Preferred:

• Graduate of an accredited Medical or Dental Billing Certificate program.

Experience 

• Customer service related experience working with the general public (2 years).
• ICD-10 coding experience (1 year); or a combination of equivalent education and work experience.
• CPT-4 coding experience (1 year); or a combination of equivalent education and work experience.
• Data entry experience (2 years).
• Working with insurance/billing in a healthcare setting (2 years).
• Working with private and/or government third party reimbursement (1 year).
• Reading remittance advice and explanation of benefits (EOB) across various payer sources experience (1 year).

Preferred:

• CDT-5 coding experience.
• Healthcare information systems, such as electronic health record and practice management systems experience (3 years).
• Working with low income, multi-ethnic populations.
• Understanding of electronic auto posting technology related to 835 files.
• Understanding of standard American National Standards Institute (ANSI) reason codes.

Credentials

Preferred:

• Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) or Coding Specialist (CCS) certified by the American Health Information Management Association (AHIMA).

Job Specific Functions/Performance:

1. Verifies insurance coverage and submits claims to insurance companies.
2. Assists patients in setting up payment plans and completes payment plan contracts.
3. Posts daily payments to practice management system and enters contractual adjustments, as necessary. Ensures that all payments, adjustments and denials are posted timely and accurately. Tracks and follows up on appeals and corrections in a timely manner.
4. Adheres to established quality and quantity standards of the department.
5. Consults with Certified staff to receive written approval before changing codes, including, but not limited to, codes listed on current delegation list.
6. Serves as a resource for staff on all aspects of insurance programs, discount applications, provider coding, payment plans and patient payment processing.
7. Performs all aspects of A/R resolution, including, but not limited to, researching denied and incomplete claims and using appropriate methods for appeals and corrected claims.
8. Stays current with payer requirements regarding overpayments, takebacks, claim corrections, and submissions.
9. Performs various collection actions, including but not limited to, correcting and resubmitting claims to third party payers and tracking and reporting delinquent accounts to collection agency.
10. Prepares and sends patient statements.
11. Assists with processing discount fee adjustments and enters tracking data into sliding fee database.
12. Scans various documents, including, but not limited to, statement verifications, collections, OB billing and invoices.
13. Ensures all customer service inquires have been addressed. This includes researching patient questions regarding accounts/statements and initiates appropriate corrections, adjustments and/or resubmission of claim(s). Reconciles patient credit balances and initiates refund requests.
14. Researches and reconciles patient and third party credit balances and initiates refund requests.
15. Adheres to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care.

CHC is an Equal Employment Opportunity/Affirmative Action Employer (EEO/AA)/At-will employer.