Patient Accounts Specialist I

MedStar Health is seeking an experienced Patient Accounts Specialist to join our Patient Accounting team, supporting non-governmental follow-up for the Washington DC MedStar Health hospitals.

This position requires experience in facility and/or physicians' claims follow-up and a strong understanding of denial resolution and appeals processing to ensure timely and accurate reimbursement

As a department, this team works all Commercial, Blue Cross, HMO, MCO, Medicare Advantage and Workers' Comp payers for the DC MedStar Health hospitals.The team does "follow up" on accounts that have been billed and no payment has been received or when only partial payment is received. The team issues written appeals for denials.The DC facilities work off a contract-based reimbursement system, so team members are familiar with all the contracts for each payer for each facility.To make it more manageable, each team member has a dedicated payer or group of payers, depending on the volume that they work.Team members are cross trained as needed.

General Summary of Position
Interprets and evaluates appeals to include follow-up with payers to assure timely turn around for claims resolution and reimbursement. Must be able interpret explanation of benefits and have a clear understanding of payer methodology. Works in a team environment.

Primary Duties and Responsibilities

• Keeps abreast of regulatory and specific changes as it relates to billing requirements and payer specific follow up.
• Maintains daily performance benchmarks as it applies to interpreting and evaluating appeals to include follow up with payers. Completes coding report updates within the standard set in a timely manner to begin the daily workflow process. Responsible for reconciliation of reports to SMS and information that was posted.
• Maintains departmental QA standard within established error rate.

Minimal Qualifications
Education

• High School Diploma or GED required

Experience

• 1-2 years' experience in patient accounting, accounts receivable or related healthcare field required or an equivalent combination of experience and college education in accounting finance or healthcare administration required

Knowledge Skills and Abilities

• Detailed working knowledge and demonstrated proficiency in at least one specific payer's application billing and/or collection process.
• Requires basic working knowledge of UB04 and Explanation of Benefits (EOB).
• Requires some knowledge of medical terminology and CPT/ICD-10 coding.
• Excellent communication analytical interpersonal and organizational skills.
• Proficient uses of hospital registration and/or billing systems and personal computers as well as Microsoft Excel and Word applications.
• Ability to type 35 WPM.