Patient Accounting Specialist

Works collaboratively with department leadership to review and manage open Accounts Receivable, accurately documenting follow-up activities resulting in the resolution of underpayments and denials. Works claim edit work queues to review, correct or adjust claims prior to being sent to insurance to reduce denials and increase reimbursement. Conducts root cause analysis of denials and takes the action necessary to resolve the denial escalating accounts to management that need to be submitted to the provider representative for contracting action. Identifies denial and underpayment trends that require computer system modifications and recommends necessary to implement corrective action. Prepares reports for meetings with provider representative and senior leadership, as required. Demonstrates the ability to apply LVHN EMS insurance contracts terms to claim payment reviews and the ability to determine if the source of an underpayment is related to a contract management discrepancy, an underpayment, or a line item denial. Demonstrates knowledge of insurance carrier reimbursement requirements to evaluate underpayments that are related to insurance carrier clinical and payment policies. Responsible for the entire Rev Cycle including charge entry, verify trip sheet for correct CPT codes, diagnosis, and mileage. Demonstrates knowledge of and compliance with established organizational and departmental policies, procedures, objectives and goals. Works collaboratively with management to establish issue logs and account examples for meetings with the insurance carrier provider rep.