Patient Accounts Specialist II - Physicians Billing

MedStar Health has an opening for an experienced Patient Accounts Specialist (Level II) to join our Physicians' Billing team and work remote from home! To be successful, candidates must have a minimum of four years of experience in hospital/physician patient accounts and collections in medical billing operations.

General Summary of Position
Under general supervision performs accounts receivable follow-up/collection procedures to obtain timely reimbursement from third party carriers and other payment sources on moderately complicated invoices in a Direct Contract assignment and/or with an invoice balance. Performs collection activity for assigned divisions, third party carriers and individual providers. Maintains contacts with third party carriers and communicates billing/reimbursement changes to management in a timely manner. Assists in evaluation of A/R and participate in development of collection strategies to decrease outstanding A/R.

Primary Duties and Responsibilities

• Actively and continuously improves work processes for self. Uses continuous improvement tools and methods to improve individual team and cross-departmental performance. Bases improvements on customer requirements data root-cause analysis and outcomes.
• Assists in creation/implementation of in service training materials and presentation for team development.
• Assists in the planning of work for self and Insurance Specialist including setting goals, prioritizing work and coordinating the execution of work. Assists supervisor in planning, coordinating and direction of daily work activities of clerical billing and collection staff. Assists supervision in collection activities and functions.
• Assists with determining organization processes that maximize cash receipts.
• Bills patient accounts and assures accuracy by reviewing and verifying patient charges coordinating benefit level type of coverage and/or approval for coverage.
• Collects insurance accounts by contacting insurance carriers and other third party payers to verify receipt of billing and other information needed to process claims secure approximate date of payment negotiate with claims personnel for prompt payment and resolve discrepancies in billings within appropriate time frames.
• Communicates effectively with staff at all levels of organization both inter and intra-departmentally.
• Contacts and participates in meetings with internal and external customers to resolve difficulty payment or process issues.
• Develops productive relationships with payer representatives to secure timely payment of claims.
• Forwards bill to third party payers and/or enters billing information into computerized billing system.
• Interprets data and reports to determine work priorities and resource allocation across multiple billing and collection tasks.
• Investigates and resolves insurance claim rejections.
• Meets the Performance ETM Production quota set at 90% of the established quota.
• Participates in educational/professional development activities. Exemplifies Guest and Staff Relations standards in all activities in areas of service resource utilization high quality outcomes and effective communication. Provides guidance and instruction to fellow team members when necessary.
• Provides information regarding work progress actions and issues in a timely and effective manner. Recommends improvements.
• Recommends timely invoice adjustments.
• Reviews and monitors work quantity and quality recommends the allocation of resources helping to ensure departmental goals are met or exceeded.
• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
• Performs other duties as assigned.

Minimal Qualifications
Education

• High School Diploma or GED required
• Associate's degree and/or Bachelor's degree preferre
• Consideration will be given to an appropriate combination of education/training and experience.

Experience

• 4 years of progressively responsible experience in hospital/physician patient accounts or equivalent experience required
• Experience and proficiency using an automated billing system, GE IDX and ETM experience

Knowledge Skills and Abilities

• Effective negotiating skills to include ability to resolve complex billing and collection situations with individual patients or third party payers.
• Proactive problem solving skills.
• Ability to interpret data and related information and discern trends and tendencies as well as determine appropriate course of action.
• Ability to work as part of team, set goals, prioritizes work and assist in the coordination and execution of work.
• Ability to assist in the following areas: lead, monitor daily activities, evaluate, train and motivate performance of team members.
• Effective verbal and written communication skills.
• Knowledge of ETM basic operation of hardware and work processing and spreadsheet packages preferably Microsoft.
• Knowledge of relevant billing and collection laws and regulations hospital protocols.
• Knowledge of third party claims and diagnostic coding to include ICD 9/10 and CPT coding.
• Demonstrates proven successful organizational and analytical skills that ensure consistent completion of daily quota driven processing.