PATIENT ACCOUNT SPECIALIST

The Purpose Driven Career Objectives of a Biotechnology / Pharmaceutical / Medical / Healthcare at KMC:

Patient Account Specialists play a crucial role in ensuring an efficient RCM process at both the claim and patient levels. They manage patient accounts from Eligibility to charge submission all the way through tofinal resolution, working collaboratively to ensure the successful collection of all outstanding accounts receivable. This includes timely payment posting and successful appeals to expedite reimbursement.

To apply for Biotechnology / Pharmaceutical / Medical / Healthcare, you are excellent at:

• Scrub and submit daily charges to various payers.
• Complete daily eligibility and benefit verification for all facilities utilizing best practice processes
• Document financial and pre-certification information according to defined process in a timely manner.
• Maintain and update patient demographic information and insurance details within the billing system.
• Communicate with the front-end staff regarding patient deductibles, copays, and scheduling, ensuring accurate billing information is captured and communicated.
• Locate remittances and payments in various portals.
• Read and interpret Explanation of Benefits (EOBs).
• Post payments manually or electronically (ERA), including patient and insurance payments, adjustments, and denials.
• Transfer copay, coinsurance, and deductible balances to patient responsibility.
• Review patient account balances to ensure posting accuracy as needed.
• Perform payment and bank reconciliations.
• Conduct daily cash reconciliation and reporting.
• Research and resolve unapplied accounts.
• Review EOBs to ensure appropriate steps are taken in resolving accounts; investigate, follow up with payers, and take appropriate action on insurance and legacy accounts assigned.
• Ensure proper claim submission and payment through review and correction of claim edits, errors, and denials.
• Solve practical problems and deal with various concrete variables in situations with limited information.
• Effectively communicate via the CRM ticketing system with clients and internal staff members.
• Submit requests to clients for medical records as needed.
• Stay informed about current department policies and procedures.
• Meet or exceed quality and quantity benchmark targets established by management (e.g., productivity, AR days, cash collections, bad debt, past-due follow-up).
• Ensure the confidentiality of all patient accounts by following HIPAA guidelines.
• Respond timely and accurately to all incoming correspondence and inquiries from insurance companies and other appropriate parties.
• Post payments manually or electronically (ERA), including patient and insurance payments, adjustments, and denials.
• Locate remittances and payments in various portals.
• Transfer copay, coinsurance, and deductible balances to patient responsibility.
• Review patient account balances to ensure posting accuracy as needed.
• Perform payment and bank reconciliations
• Conduct daily cash reconciliation and reporting.
• Research and resolve unapplied accounts.

Your Success Profile includes:

• High school diploma or equivalent; college degree preferred.
• Recent experience in vision care claim processing or a similar role in healthcare insurance is highly desirable.
• Experience in Insurance Verification & Eligibility
• Strong and current knowledge of vision care insurance policies, procedures, and clearinghouses.
• Ability to do medical coding in ICD-10, CPT, HCPCS, and modifiers for professional fees.
• Excellent organizational and time-management skills.
• Exceptional communication and customer service skills.
• Proficiency in using claim processing software and Microsoft Office Suite.
• Attention to detail and ability to multitask effectively.
• Ability to work independently and as part of a team.
• Adheres to internal and system-wide competencies, behaviors, policies, and procedures to 
• Ensure efficient work processes