Acct Resolution Rep II

Responsibilities

• Maintain a working knowledge and perform assigned duties in compliance of all-departmental billing and follow-up policies, procedures, processes and functions.
• Respond appropriately to inquiries from 3rd parties, insurance providers and patients regarding accounts, collection issues and hospital policies, to insure a minimal Accounts Receivables inventory.
• Collect and resolve payments from insurance companies by working with assigned payers and utilizing established policies and procedures.
• Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract.
• Successfully appeal denied accounts and avoid excessive deferred accounts.
• Demonstrate effective collaboration skills, and support to the follow-Up staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of workflow, as instructed by leadership.
• Review account receivables while evaluating trends and tracking recovery efforts by utilizing various departmental tools optimizing individual workflow and process to reduce AR growth, quickly propose solutions to reduce trends, resolve issues, etc.
• Consistently meet the productivity and quality standards.
• Assist staff by providing direction and guidance, creating a team environment through training, recognition, and education which produces optimum work habits and job performance.
• Aid in setting obtainable short-term goals, maintaining expected level of productivity and quality as defined by policy, or equivalent industry standards when not specifically defined by policy, as well as assisting with performance studies to improve productivity, streamline operations and reduce error rates.
• Provide assistance with staff training and oversight to ensure that implemented policies and procedures are being followed.
• Meet deadlines established through interaction with the Manager of Accounts Resolution or other senior leadership.
• Review and improve work procedures to ensure that the most productive and efficient methods are used.
• Monitor progress for assigned workflow on a daily basis, utilizing quantitative technology and tools and providing feedback to leadership regarding success and obstacles to claim resolution.
• Assist with departmental projects and presentations, as needed.
• Resolve complaints and misunderstandings in a timely and appropriate manner while demonstrating the ability to tactfully handle difficult situations through an approach that reflects consistency and fairness.
• Act as an internal resource; resolving problems and providing expertise to other hospital departments.
• Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership.
• Maintain a working knowledge of WellStar policies and procedures.
• Maintain membership and active participation in the HFMA professional organization or equivalent, to participate in workshops and classes ensuring a competency level beneficial to the department, as well as to meet minimum requirements in technology advances/applications.
• Maintain professional relations and convey relevant information to other members of the team within the facility and any applicable vendors.
• Participate in the Revenue Cycle Task Force, Monthly Denials Task Force, Monthly Compliance Coding Partnership as well as other committees as assigned.
• Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Manager of Accounts Resolution aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public.
• Assist with reviewing denial reports and determining significant problems causing rejections and denials; communicate with the leadership of Accounts Resolution the findings and proposes denial prevention solutions.
• Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt & Collection Act guidelines, Medicare & Medicaid regulations and reimbursement methodology, as well as state and federal laws.
• Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues.
• Aid in the development, processes and efficiency of Insurance Follow-Up and Denial policies & procedures to ensure they are comprehensive in nature and current/updated.
• Consistent review of current processes to ensure compliance with policies and procedures.
• Aid in establishing controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly.
• Aid in ensuring optimal system capabilities by assisting with staff training, documenting system parameters, challenging systems and obtaining feedback from staff/users.

Qualifications

• Minimum Education: High school diploma or equivalent.
• Required and Certified Advanced CPAR or equivalent is strongly Required.
• Required Minimum Experience: Experience as an Account Follow-up Representative I or a minimum of two (2) years in hospital patient financial services or related area.
• Required Minimum Skills: Strong interpersonal, mathematical, analytical, computer, problem solving and writing skills, with a “take charge” attitude. Must be comfortable interacting with insurance providers, physicians and leadership. Must be able to perform a wide variety of tasks that require independent judgment, ingenuity, and initiative. Competent with MS Word, PowerPoint, and MS Excel is required as critical analysis will be conducted using this technology.
• Additional Licenses and Certifications: Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.