Patient Financial Services Associate – II

This is a fully remote position, open to applicants in United States.

📋 Description

• Accurately and promptly process claims, appeals, denials, and statements

• Address billing discrepancies, eligibility concerns, denials, appeals, and overdue unpaid claims for commercial, government, and plan coverage

• Relay insurance information to ancillary departments and ensure proper coverage using Epic, external portals, and various software tools

• Review and resolve payer denials, appeals, and claims lacking payer response through portals, payer calls, and system investigations

• Comprehend explanations of payments to settle backend claims

• Verify and investigate patient insurance eligibility and rectify accounts in Epic, including demographics, financial, and guarantor data

• Engage with insurers and third-party payers to acquire and document authorizations

• Investigate missing or incorrect account information using portals and additional resources, including identifying unknown payers

• Review and adjust claims and appeals prior to clearinghouse submission

• Examine and resolve claim issues in accordance with federal, state, and payer regulations and procedures

• Amend rejected claims from claim scrubbers, clearinghouses, or payers

• Analyze explanations of payment and undertake necessary actions for denials, including appeals, write-offs, or patient statements

• Investigate payer underpayments and follow up on unpaid aging claims via phone

• Supply supporting documentation to insurance payers

• Execute accurate and timely write-offs for uncollectible accounts

• Participate in team meetings and discuss denial trends to enhance front-end claim edits and first-pass resolution

• Offer workflow and best-practice suggestions to boost performance, processes, and net revenue collections

• Provide ad hoc departmental support for special projects and during outages or high-volume periods

• Uphold confidentiality and adhere to HIPAA regulations and the Quality Management System

• Function independently and collaboratively while embodying Abbott’s mission and values

⛳️ Requirements

• High School Diploma or General Education Degree (GED)

• Minimum of 2 years of experience in medical billing, claims, and/or insurance processing

• Comprehensive and up-to-date knowledge of government, managed care, and commercial insurance claim submission requirements, reimbursement guidelines, and codes

• Familiarity with medical terminology and/or health insurance vocabulary

• Understanding of EHR operating systems and electronic records

• Proficient in computer systems and possess strong keyboarding skills

• Exceptional attention to detail and a commitment to quality output

• Capability to perform essential duties with or without accommodation

• Authorization to work in the United States without sponsorship

• Availability to work Monday through Friday during standard business hours

• Ability to work at a computer and/or type for approximately 90% of the workday

• Capacity to operate a computer and phone simultaneously

• Proficient in using a telephone with a headset

• Successful completion of an Epic processes assessment with a score of 80% or greater

• Preferred: Related associate degree or medical billing certification

• Preferred: Over 4 years of experience in medical or insurance billing

• Preferred: Experience with Epic or another EHR application

🏝️ Benefits

• Remote work options available

• Reasonable accommodations offered for employees with disabilities

• Equal opportunity employment