Patient Accounts Specialist II

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