Team Leader Patient Accounting
Job Summary Researches and analyzes complex and escalated accounts to identify and complete appropriate steps needed for resolution including, but not limited to, the research and resolution of Medicare Exhaust, Coordination of Benefit conflicts, Recovery Audits, and MSP Verification. Recognizes, documents and communicates account and payer trends. Works in collaboration with all teams, payers and patients, utilizing resources to resolve multiple primary and secondary billing, collections, and customer service issues. Minimum Qualifications Education/Training High school graduation or equivalent. Associate's degree in healthcare preferred; courses in Accounting, Finance and Healthcare Administration preferred. Experience 1 year experience in patient accounting or in a hospital-based department (systems, billing,medical records, registration, finance), or an equivalent combination of education and experience. Knowledgeo f medical terminology and payer billing preferred; leadership experience preferred. License/Certification/Registration CRCS-I (Certified Revenue Cycle Specialist) certification through AAHAM is required or CRCS-I certification within 1 year of hire date in role with an Associate's degree. Knowledge, Skills & Abilities Self motivated, critical thinker with detailed working knowledge and demonstrated proficiency in the major (Medicare, Medicaid and Blue Cross) payer's billing and/or collection process, including an understanding of the Florida Shared System (FSS) and guidelines of Medicare as the secondary payer(MSP). Understanding of billing specifications and contractual arrangements and/or multiple payer's insurance verification and pre-certification requirements. Requires working knowledge of UB04 and Explanation of Benefits (EOB) and knowledge of DRG reimbursement, medical terminology and CPT/ICD-9coding. Team Player with excellent communication and interpersonal skills. Excellent organizational skills to manage multiple tasks in a timely manner. Proficient use of hospital registration and/or billing systems/websites (Carefirst Direct, Medicaid State portals, etc.), and Microsoft Office applications. Primary Duties and Responsibilities Completes training in the SMS Patient Accounting, Patient Management, and Receivable Workstation applications. Attends training sessions and workshops offered, to include but not limited to, CPAT training, bulletin review, etc. Attends and successfully completes required Continued Education Units (CEU) for the PFS Training program. Completes annual mandatory training (SiTEL) within defined time frame. Contributes to the achievement of established department and Patient Financial Services goals and objectives, and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations. Achieves established team benchmarks. Keeps abreast of regulatory and specific changes as it relates to UB04 and HCFA 1500 billing requirements and payer specific follow up. Maintains daily performance benchmarks pertaining to follow-up. Maintains departmental QA standards within standard error rate. Meets team specific benchmark as it applies to PXPAID, Disputed Claims, open receivable, recovery audits, and credits. Participates in PFS workgroups, staff meetings and work events. Performs other duties as assigned. Processes and completes the daily billing of paper claims including timely communication back to the Billing Team as appropriate. Provides guidance for Team with the Receivable Management Workstation (RMW). Reviews and processes the Collector's Work list, ensuring that reports are properly worked and those uniform collection follow-ups based upon payer specific requirements are in accordance with departmental policies and procedures. Analyses collector productivity, workload and issues in cooperation with the supervisor to determine action needed for performance improvement. Provides ongoing training to staff as new issues are identified. Reviews accounts to determine action required expediting payment and resolving delinquency. Consistently reviews accounts by utilizing all resources and documentation. Inquires through online systems to obtain status of claims. Reviews accounts to determine action required to expedite payment and resolve delinquency utilizing all resources. Reviews daily and reports recurring and new SMS system and registration issues. About MedStar Health MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, DC, region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.