PATIENT ACCOUNTS SPECIALIST II

JOB SUMMARY

The Patient Accounts Apecialist II prepares and follows-up all third party and patient bills, as organized and directed by the Patient Accounts 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

• Assist with answering the Patient Customer Service line

• Attend quarterly payer meeting with respective payers

POSITION REQUIREMENTS

Educational Requirements

High School Diploma or GED

Licensure, Certification and Registration 

NA

WORK ORIENTATION AND EXPERIENCE

Must have 3yrs experience in hospital and/or professional collections

Strong payer knowledge base - Maryland Medicaid experience a plus

Extremely accurate with figures and data entry

KNOWLEDGE, SKILLS AND ABILITIES

Strong analytical skill a must

Must be reliable and 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:  NA

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. Must be a team player.

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