Reconciliation Representative

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

About the role

The Reconciliation Representative performs adjudication of the accounts that have payment and/or denial postings across the Hackensack Meridian Health (HMH) network. This process verifies that the payment received for the account is equal to the expected reimbursement and identifies issues for management regarding significant variances on Accounts Receivable after payment is posted. Timely adjudication of accounts prevents Accounts Receivable from aging and achieves the targeted goal on a monthly basis.

Responsibilities

• Reviews organizational billing practices to ensure invoice/claims accuracy and proper revenue recognition.
• Acts as a liaison with other departments to adjust or reconcile financial data.
• Researches customer complaints and makes necessary adjustments and/or recommendations to resolve issues.
• Analyzes and records variances in Epic at time of account adjudication.
• Accurately and thoroughly documents activity performed.
• Performs account analysis to ascertain the balance on an open account to determine if balance is due from payer or patient.
• Maintains inventory, adjudicates timely, and resolves high priority issues to prevent accounts from aging unnecessarily.
• Processes all denials and correspondence in a timely manner; analyzes, categorizes, and routes all denials to initiate an appeal process which ensures maximized revenue and cash flow.
• Evaluates credit balance for patient and health plan refunds and assesses patient accounts to calculate accuracy of refund.
• Ensures timely processing of patient refund to avoid patient complaints.
• Researches and verifies validity of daily credit card chargeback.
• Reconciles Managed Care, Medicare, and other Governmental payments and/or denials to the explanation of benefits.
• Performs comparison of EOB to the negotiated rates for accuracy of reimbursement.
• Posts appropriate allowance due to system calculation discrepancies.
• Communicates issues and causes of manual allowance to management relating to contract management, payer, or high volume issues to prevent future occurrence.
• Provides statistical data on payment discrepancies, enabling management to accurately monitor Accounts Receivable activity on an ongoing basis. Data provided will be forwarded to Information Technology for contract management correction and/or updates, which may also result in payer escalation.
• Escalates accounts that need coding or billing review.
• Responds to patient or payer phone inquiries regarding refund process and payment-related inquiries.
• Receives and researches Customer Service, front-end, and other departments' inquiries as needed to resolve specific account issues.
• Performs analytical support to Patient Accounting and Finance staff as it relates to monthly cash receipt and posting.
• Contacts payers, patients, other departments, and/or agencies to secure the appropriate information to properly adjudicate the account.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Requirements

• Associate's degree with a concentration in Accounting, Finance, Billing, Coding, another related field, or equivalent relevant experience.
• Minimum of 2+ years experience in patient accounting/revenue cycle operations or relevant experience/training.
• Demonstrated knowledge of Managed Care Contracts, Medicare, and Medicaid.
• Possesses beginning to working knowledge of subject matter.
• Proficiency in Google Suite/Microsoft Office applications, SMS, EPIC, and/or other hospital billing systems.
• Good analytical skills.
• Excellent written and verbal communication skills.
• Excellent interpersonal skills.
• A certain degree of creativity and latitude is required.

Qualifications

• Experience in Healthcare (preferred).
• Good basic accounting skills (preferred).
• Fast and accurate data entry skills (preferred).
• Must successfully pass completion of EPIC assessment within 30 days after Network access granted.

Pay

Minimum rate of $24.34 hourly. The posted rate of pay is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer, and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on labor market data, experience, education, certifications, skills, geographic location, internal equity, and budget or grant funding.

Benefits

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. Certain positions may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate, as well as shift differentials for work performed on evening, night, or weekend shifts.