Please Note:
SCREENING QUESTIONS - PLEASE INCLUDE WITH SUBMISSION (EITHER AS A COVERSHEET WITH RESUME OR AT THE TOP OF RESUME)
• This is an On-Site position.
• Work Unit: Accounting(Biller)
• Work Schedule: Monday-Friday 8:30 am - 5:00 pm
• Reporting address: 1501 Sulgrave Ave, Baltimore, MD 21209.
• Dress code: Business casual.
JOB SUMMARY:
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.
SCREENING QUESTIONS -
Please Include With Submission (Either as a cover sheet with resume or at the top of resume)
• What is the Birthday Rule, and what is it used for?
• Explain your understanding of how Maryland Medicaid is set up/how it works. For example, if a 16-year-old patient has Maryland Medicaid with an MCO, where would a claim be sent to for each of the following types of service?
• Medical Charges?
• Rehabilitative or Habilitative Therapy Charges?
• Behavioral Health charges?
• What is Maryland Medicaid’s process for billing late charges or a corrected claim? (Not to the MCO – for straight MA.)
• What is Coordination of Benefits?
Requirements JOB REQUIREMENTS:
• High School Diploma or GED
• 3 years of prior experience in hospital collections.
• Strong payer knowledge base.
• Extremely accurate with figures and data entry.
• Strong analytical skills are a must.
• Must be able to work unsupervised.
• Must be able to work with a calculator, PC, and Excel
• All other duties as assigned or requested
JOB FUNCTIONS:
• 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