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    patient accounts specialist ii - Baltimore, United States - Mt. Washington Pediatric Hospital

    Mt. Washington Pediatric Hospital
    Mt. Washington Pediatric Hospital Baltimore, United States

    6 days ago

    Default job background
    Full time
    Description

    JOB SUMMARY

    The Patient Accounts Specialist II prepares and follows-up all third party and patient bills, as organized and directed by the Patient Finance Manager/Director.

    ESSENTIAL FUNCTIONS OF POSITION


    • Work aged receivable utilizing A/R reports and received correspondence and other department inquiries


    •Review and assess adjudicated claims for timely and proper payment of outstanding balances


    •Research, correct and resubmit or reprocess unpaid claims as necessary


    •Submit adjustment request daily as necessary


    •Verify validity of account balances by researching, review and ensuring accuracy of charges, payments and adjustment posting and ensure account balances are assigned to the correct payer buckets


    •Review and interpret Explanation of Benefits (EOB) for denials and underpayment of codes


    •Research and resolve denials and underpayments with insurance carriers


    •Identify payer denial trends


    •Confirm insurance eligibility and confirm carrier policy for referral and auth requirements as needed for claim adjudication


    •Submit carrier appeals and reconsideration request in a timely manner


    •Identify and submit the required insurance refund request to refund specialist according to policy and procedure


    •Meet productivity goals/benchmarks as set and communicated Department leadership


    •Serve as a customer service representative for patient inquiries/calls


    •Maintain confidentiality of patient information


    •Work collaboratively with other departments and coworkers as needed


    •Attend quarterly payer meeting with respective payers

    POSITION REQUIREMENTS

    Educational Requirements

    High School Diploma or GED

    Licensure, Certification and Registration

    N/A

    Work Orientation and Experience

    Must have minimum 3 years experience in hospital and/or professional claim follow up

    Strong payer knowledge base

    Extremely accurate with figures and data entry

    Knowledge, Skills and Abilities

    Strong analytical skill a must

    Must be able to work unsupervised

    Must be able to work with a calculator, PC and Excel

    All other duties as assigned or requested

    Other Requirements Specific to Assigned Area

    REPORTING RELATIONSHIPS

    Supervision Received - Patient Accounting Manager, Patient Accounting Director

    Supervision Exercised - N/A

    INTERPERSONAL RELATIONSHIPS

    Communicates daily in person or by telephone with hospital staff and insurance companies. Must also be able to

    handle sensitive situations in a professional manner.

    TOOLS/EQUIPMENT USED

    Calculator, Facsimile machine, PC, Telephone, Internet, Copy machine, Printer

    PHYSICAL ENVIRONMENT/WORKING CONDITIONS

    Typical health care environment, stress due to multiple demands, shifting priorities and tight timeframes. Little or no risk of exposure to body fluids, infectious waste or blood borne disease.

    This job description identifies the general nature and level of work to be performed. It is not to be considered an exhaustive list of responsibilities, duties or skills required of an incumbent.

    Revised 3/3/20

    Revised 1/1/22

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