JOB SUMMARY – PATIENT ACCOUNTS SPECIALIST II

Join a team of dedicated Patient Accounting specialists committed to helping the patients and families of Mt. Washington Pediatric Hospital, where everyone contributes to the mission of maximizing the health and independence of the children we serve.

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. Hybrid remote/on-site options may be available after training period.

ESSENTIAL FUNCTIONS OF POSITION

• Work aged hospital receivable utilizing A/R reports, 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/Equivalent preferred

Licensure, Certification and Registration

• None

Work Orientation and Experience

• 3 years prior experience in hospital collections

Knowledge/Skills/Abilities

• Must be computer proficient - PC, Outlook, Word, Excel.
• Previous Meditech experience is a plus.
• Previous hospital Commercial and/or Military payer follow-up experience is a plus.
• Extremely accurate with figures and data entry
• Strong analytical skills a must
• Demonstrates excellent customer service skills
• Highly effective interpersonal skills
• Must be able to work unsupervised
• Working knowledge of adding machine, calculator, fax machine, printer and copier
• Must be efficient and a multi-tasker

Other requirements Specific to assigned Area

Reporting Relationships

• Supervision Received
• Reports directly to Manager/Director

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

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 3/31/22