Patient Accounts Spec II

Position Summary

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we have grown into a 3,900-bed healthcare organization that delivers care for more than 142,000 inpatient and 3.9 million outpatient visits each year. Our 24 award-winning hospitals and ERs, 9 specialty institutes, 14 urgent care centers, 100+ primary care practices and more than 60 outpatient facilities serve communities that span Florida’s east to west coasts and beyond.

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing free education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. “Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you.

Position Summary: The Patient Accounts Specialist II is responsible for promoting accurate reimbursement for the organization by ensuring timely and accurate billing and collection of accounts. This individual identifies and analyzes payment variances to enact and effectively communicate corrective measures that resolve payer errors.

• Resolve inaccurate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.
• Utilize specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account’s ability to pay after initial rejection from payer.
• Coordinate duplicate billings, coordination of benefits, medical records and clinical documents as needed to expedite payment of insurance claims.
• Assist Patient Accounting Rep III with the planning and organizing of departmental activities as needed.
• Analyze underpayments and over payments to identify root causes and examine claims to ensure payers are complying with contractual agreements.
• Collaborate with payer contracting and other areas of the revenue cycle, if necessary, to resolve issues pertaining to a claim payment.
• Communicate directly with payers to follow up on outstanding claims and resolve payment variances, respond to payer inquiries and concerns, and work to develop and maintain positive relationships with payers.
• Help resolve accounts from other team members’ workloads to prevent backlogs and fill in as needed for absent team members.
• Maintain account follow‑up for all assigned accounts.
• Maintain system work queues based on electronic payers’ error reports as assigned, including but not limited to DNB, Claim Edits, Front End Rejections, and No Response from payers, Variances, underpayments, over payments.
• Maintain reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintain compliance with all Orlando Health policies and procedures.

Other Related Functions:

• Participate in departmental meetings.
• Perform other duties as assigned.

Education/Training

• High School diploma or GED required.
• Must complete Orlando Health team member development within 6 months of hire date.
• Work efficiently with Microsoft applications (Outlook, Word, Excel, PowerPoint).

Licensure/Certification

• HFMA Certified Revenue Cycle Representative (CRCR) certification received within six (6) months.

Experience

• One (1) year experience as a Patient Accounts Specialist I or a minimum of two (2) years’ experience in a related field (medical billing/collections/managed care).
• Associate degree in Healthcare Administration, Communications, Business Finance, or related area of study may substitute for 2 years of related experience.