Patient Services Coordinator

REMOTE Claims Specialist ***Supporting the PacMed network of outpatient clinics in WA state. Candidate MUST reside in WA state.***

• Contract Length: ASAP through June 2027 (~33 weeks, assuming mid-November start)
• Shift Schedule: Mon-Fri, 5x8hr // Candidate will have a set schedule but general shift times can fall anywhere from 7am through 5pm.
• Orientation: Orientation occurs every 2 weeks at the PacMed Beacon Hill clinic (1200 12th Ave S, Seattle, WA 98144). Candidate would be on-site in Seattle for orientation on their first day.

GENERAL SUMMARY:

The Claims Specialist ensures patient account and claim information contains comprehensive and accurate data to provide for timely billing and optimal reimbursement for services. Monitors daily electronic claims transmission to research and resolve system and electronic clearinghouse claim rejection to maximize the number and percentage of patient bills processed without denials or errors. Responsible for ensuring all claims are accurate and compliant with government rules and regulations. Coordinates billing within the functions of registration, edits, and follow up. Works closely and communicates with insurance companies, government payers, hospital staff, physicians, patients and others to ensure timely billing and resolution of patient accounts.

ESSENTIAL FUNCTIONS:

***The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position. The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending upon the nature of the position. Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization.***

• CUSTOMER SERVICE: Demonstrates professional skills in working with departmental staff, hospital departments, physicians, physician's office staff, government agency and insurance company representatives, patients, consultants and co-workers. Maintains confidentiality of all patient information.
• REGISTRATION AND CHARGING: Ensures all billing documentation required by payers, including but not limited to CPT-4, HCPCS and ICD-10 coding, prior authorization, provider identifications, primary and secondary insurance, patient demographics, insured identification, charges and dates of service are complete and correct. Researches and corrects system and clearinghouse edits.
• BILLING AND RESOLUTION: Performs follow-up with patients and insurance payers to ensure timely and accurate resolution of accounts within departmental guidelines and government program regulations. Works to facilitate resolution of billing and coding inconsistencies. Performs necessary research to facilitate coding requirements in general and for payer specific policies. Researches and resolves insurance denials following the departmental job aids.
• DAILY OPERATION: Demonstrates working knowledge of registration, billing, retrieval, electronic data interchange and online systems, i.e., Registration and Billing Software, Tri-Care/Champus, Medicaid, Medicare, Veterans Administration and Imaging Systems. Possess working knowledge of CPT-4, HCPCS and ICD-10 coding requirements. Responsible for billing, account follow-up, account maintenance, review and analysis of RA's and customer service. Possesses the ability to detect system integrity problems, reports and assist in resolution. Keeps current in rules and regulations as they change.

• COMMUNICATION AND TEAMWORK: Demonstrates professional telephone skills. Demonstrates professional inter-personal skills in communicating with patients and others regardless of age, nationality, or financial situation. Collaborates with team members to achieve a wide range of department specific duties and activities to maintain maximum productivity and success.
• EQUIPMENT: Operates equipment in a safe manner according to department procedures. Operates multiple kinds of equipment. Identifies equipment in need of repairs and informs secretary. Utilizes equipment in the prescribed manner.
• CRITICAL THINKING SKILLS: Utilizes available resources, ie, seeks answer prior to asking for help. Example: PPA contracts, government regulatory requirements and guidelines. Recognizes errors/problems and corrects. Analyzes situation and makes a decision within department guidelines.
• ACCURACY AND PRODUCTIVITY: Is self-directed and displays initiative to maintain personal productivity and flexibility. Completes work accurately and according to procedure. Performs work according to department productivity standards.
• COMPLIANCE: Responsible to obtain the necessary knowledge and experience to perform job tasks in compliance with federal, state and local laws, regulations and guidelines. Participates in educational programs and in-services.
• The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position.
  The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position.
• Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies, and standards of their organization.

JOB-SPECIFIC KNOWLEDGE, SKILLS, & ABILITIES:

• Demonstrated knowledge of managed care principles, insurance industry practices, and medical terminology required.
• Analytical skills to interpret, problem solve and respond to insurance companies, patients, other staff and physicians regarding complex accounts.
• Understanding of insurance payer reimbursement.
• Working knowledge of CPT, ICD10 coding, and Correct Coding Initiatives and basic accounting.
• Strong analytical, organizational, and communication skills required.
• Excellent verbal, written, and interpersonal skills.
• Ability to operate data entry equipment and related computer systems.
• Typing skills of 40wpm.

REQUIRED EXPERIENCE:

• Minimum 2 years in healthcare business setting. Education in a related field is accepted in lieu of this work experience.
• Minimum 1 year using EPIC platform.
• Minimum 1 year of successful customer service experience with patients and insurers.