Patient Accounts Specialist I - Hospital Follow-Up

About the role

MedStar Health is seeking an experienced Patient Accounts Specialist to join our Patient Accounting team, supporting non-governmental follow-up for the Washington DC MedStar Health hospitals. This position requires experience in hospital and/or physicians’ claims follow-up and a strong understanding of denial resolution and appeals processing to ensure timely and accurate reimbursement.

The team works all Commercial, Blue Cross, HMO, MCO, Medicare Advantage, and Workers’ Comp payers for the DC MedStar Health hospitals, focusing on accounts that have been billed but no payment or only partial payment has been received. The team issues written appeals for denials. Team members are familiar with contract-based reimbursement systems for each payer and facility, with each specialist assigned a dedicated payer or group of payers based on volume. Cross-training is provided as needed.

Responsibilities

• Interpret and evaluate appeals, including follow-up with payers to ensure timely claims resolution and reimbursement.
• Interpret explanation of benefits (EOB) and understand payer methodology.
• Stay current with regulatory and billing requirement changes specific to payer follow-up.
• Maintain daily performance benchmarks for appeals evaluation and payer follow-up.
• Complete coding report updates within established standards to initiate daily workflow.
• Reconcile reports with SMS and posted information.
• Maintain departmental quality assurance standards within the established error rate.

Requirements

• High School Diploma or GED required.
• 1-2 years' experience in patient accounting, accounts receivable, or a related healthcare field, or an equivalent combination of experience and college education in accounting, finance, or healthcare administration.

Skills

• Detailed working knowledge and demonstrated proficiency in at least one specific payer’s billing and/or collection process.
• Basic working knowledge of UB04 and Explanation of Benefits (EOB).
• Some knowledge of medical terminology and CPT/ICD-10 coding.
• Excellent communication, analytical, interpersonal, and organizational skills.
• Proficient in hospital registration and/or billing systems, personal computers, Microsoft Excel, and Word.
• Ability to type 35 WPM.

Pay

This position has a hiring range of USD $18.70 - USD $32.72 per hour.