Accts Rec & Denial Spec 1 / PA Third Party Follow Up

Position Summary

Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 or HCFA1500 (bills), monitor responses from clearinghouse, review EFT (Electronic File Transmission) responses, respond on underpayments or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue cycle activities associated with outstanding insurance balances across all Hartford HealthCare hospitals, medical group and homecare.

• Manage the day-to-day work queue inflow, dashboard monitoring, weekly aging’s, Work in Progress (WIP), account activity assignment.
• Keep abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or commercial payers.
• Absorb and assist the organization to comply with all federal/state guidelines.
• Meet quality standards, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives.

Position Responsibilities

• Timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials.
• Follows up directly with commercial and governmental payors to resolve denials, underpayments, no pays, payor rejections, claim edits and credit balances.
• Reconciles outstanding balances ensuring all efforts have been exhausted (calling insurance companies, using the payer web pages, utilizing payer chat function) in resolving issues with payers prior to write-off.
• Responds to insurance companies inquiries for follow up on issues to ensure payment.
• Maintains productivity and quality performance expectations as provided by leadership.
• Documents clear and concise notes in the EPIC system regarding claim status and any actions taken on an account.
• Works with leadership to identify, trend and address root causes of issues in the AR.
• Keeps leadership informed of any issues or trends.
• Communicates with peers, management and internal colleagues to facilitate the flow of information.

Qualifications

• Education: High school diploma, GED or equivalent; Associate’s degree in health care administration, business management or finance preferred.
• Experience: 1-2 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience preferred; 3+ years of medical billing and/or accounts receivables experience in a large facility or professional healthcare revenue cycle setting.
• Licenses, Certifications, Registrations: American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification preferred.

Knowledge, Skills And Abilities

• Epic experience and working knowledge of Hospital and Professional billing modules preferred.
• Excellent analytical and problem-solving skills.
• Skill in problem solving.
• Skill in time management.
• Ability to work efficiently under pressure.
• Ability to operate a computer and related applications such as Word, Excel, PowerPoint, etc.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to deal effectively with difficult people and/or difficult situations.
• Ability to willingly accept responsibility.
• Ability to set priorities and use good judgment for self.
• Ability to exercise independent judgment in unusual or stressful situations.
• Ability to establish and maintain effective working relationships.