Patient Account Liason

Coordinates Patient Financial Services (PFS) requests for medical records, clarification of coding, and compliance with Medicare billing guidelines for Local Medical Review Policies (LMRP).

Primary Duties & Responsibilities:
1. Reviews and follows up on uncoded and unbilled accounts pending on the Outpatient Billing Exception Report and the Inpatient Alpa Di Report pending for diagnosis and procedure code(s) greater than assigned bill hold.
2. Works directly with Directors of Health Information Management (HIM) to discuss issues causing coding delays, ensures timely filing and makes recommendations for improvement. Identifies issues and trends, and facilitates the resolution of problems with the assistance of the Management team. Ensures compliance of CPT, HCPCS and ICD-10 coding regulations and guidelines.
3. Works with the Medicare Billing Team and Health Information Management Coding Managers who review outpatient accounts on a pre-billing basis for Medicare Local and National Coverage Determinations coverage edits related to billed diagnosis code(s). Searches the Medicare contractor and or the Centers for Medicare and Medicaid internet database to identify local and national coverage guidelines.
4. Coordinates the receipt, tracking and weekly reconciliation of various Medicare audits pertaining to the request of patient medical records for Additional Development Request (ADR), Probes, Office of Inspector General (OIG), Payment Error Rate Measurement (PERM) and Comprehensive Error Rate Testing (CERT) request letters generated from the various billing systems, mailed or faxed.
5. Manages the process to submit requests to designated personnel in HIM of each assigned facility or print records from various systems where appropriate. Submits completed medical record requests timely to the designated Medicare Contractor. Escalates untimely receipts of medical record requests to department management team, hospital CFO and PFS Directors as needed. Maintains a 1 201713 Pt Accts Liaison Job Description_ - Copy 1% fail rate of Medicare Technical Denials return of medical records to Medicare Contractor within 45 days.
6. Works with Medicare Follow Up Team with timeliness referral of inpatient and outpatient full and partial denials to Case Management or designated Ancillary Department for appeal. Monitors and tracks various Medicare level of appeals, refers accounts to bill Medicare Part B as appropriate and tracking appeal overturns. Processes all incoming full or partial self denial requests from Case Management referring accounts to the Medicare Billing team.
7. Maintains ongoing knowledge of UB-04, and other mandatory state and Federal billing forms and filing requirements.
8. Attends informal or scheduled staff meetings regarding policy and procedures. Meets or exceeds quality audit and assigned productivity goals.
9. Completes annual MedStar Health and Departmental mandatory training in the applications of the Invision Patient Accounting, Patient Management and Receivable Workstation applications.
10. Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
11. Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
12. Performs other duties as assigned.

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- hospital billing experience
- excel experience
- tech savvy
- experience resolving claims

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.