Patient Accounts Specialist

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk?

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, as well as stand‑alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

This is a multi‑faced role within the outpatient and service line areas. The Specialist is responsible for insurance authorisations, accurate recording of diagnosis codes, timely charge posting to support accurate billing, and collection of co‑pays at time of service. Resolve compliance and billing issues with clinical staff. May also perform scheduling and/or place orders for patient testing. Provide cross support for front office functions, including registrations necessary for the efficient day‑to‑day operation of the facility.

The Specialist serves as liaison between customers and the department. May provide oversight and training for Registrars.

• Insurance Authorization for Services/Treatment a) Verify referring Physician authorization of services and ensures all diagnosis codes are accurate and appropriate prior to service delivery; working closely and collaboratively with physician offices. b) Verify pre‑authorization or obtains authorization from insurance carrier. Works pro‑actively to ensure insurance authorization is obtained prior to rendering services or treatment; or recommends postponement of services if requirements are not met.
  
  c) Review insurance coverage information with patient, and obtain Advanced Beneficiary Notice (ABN) from patient if services are not covered. d) Work with clinical staff to assure appropriate charge capture and authorisations are received when services/treatment are altered. Coding
• Coding a) Ensure all diagnosis codes and charges are accurate according to official CPT and ICD‑9/ICD‑10 CMS guidelines, meeting all applicable State and Federal laws and regulations. b) Work actively with providers and clinical staff in problem resolution for issues related to diagnosis coding and compliance.
• Charge Capture/Billing a) Accurately post all technical and professional charges on a daily basis in appropriate hospital information system prior to export (i.e., EMR system, Horizon, etc.) b) Verify charge entries within 24 hours of posting, using defined audit processes and available reports. Follow up all fall‑out reports (i.e., Failed Bill Report from Star). Collaborate with appropriate clinical staff and manager to resolve.
  
  Perform additional charge audits as requested. c) Collaborate with supervisor/manager and Finance Department to resolve account issues as requested within billing cycle and in appropriate hospital information system (i.e., Denial and Appeals Module in Star).
• Denial Management a) Review and appropriately follow up on accounts in denial or…