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OverviewUnder the direction of the Manager of Account Resolution, the Account Resolution Representative II assists with planning and coordinating HB Accounts Resolution follow up activities for an account receivable portfolio of ~ approximately $375M-$500M, including, but not limited to collaboratively working with their Team Lead, Manager, and assisting with training, employees, as circumstances dictate. The Account Resolution Representative II will assist with the development of strategies for establishing a continuous improvement work environment, ensure eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer time frames and are documented appropriately in the patient accounting system. As well as providing educational support in a variety of departmental and individual settings. The role requires data analysis, trending analysis, and educational capabilities regarding payor and revenue cycle business related processes.
This role requires a versatile and well developed actionable understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation and provider / payor appeal requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable trending and findings is needed. The core role focus of this position is to ensure that accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Account Resolution Representative II must possess the ability to assist with developing and documenting action plans for quick resource deployment, communicate timely with leadership to understand the specific reasons for payment delays. The role requires the ability to effectively and efficiently communicate both orally and in writing to leadership, multi-task, meet deadlines, adhere to organizational policies and procedures. In addition, the Account Resolution Representative II will assist with additional Revenue Cycle related tasks and duties as assigned.
ResponsibilitiesCore Responsibilites and Essential Functions
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
* Assist with 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
* Provide assistance with departmental projects and presentations, as needed.
* Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership.
* 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.
* Must maintain a proficiency in the application of, “key automated systems” that include: Epic, Emdeon Claims Master.
* Act as an internal resource; resolving problems and providing expertise to other hospital departments
* Review write-off requests, miscellaneous cash adjustments, and submit to manager for approval
* Maintain Epic assigned workqueues to ensure timely (7 days or as specified) resolution of review requests. Become cross-trained and fill in for other staff as assigned.
* 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.
* Administrative
* Maintain professional relations and convey relevant information to other members of the team within the facility and any applicable vendors Must actively participate and support the efforts of 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 must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities.
* Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts. Assist with 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.
* Assist with establishing controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly
* Ensure optimal system capabilities by assisting with staff training, documenting system parameters, challenging systems and obtaining feedback from staff/users. Required for All Jobs
Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct. QualificationsRequired 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 and Must have a thorough understanding of Governmental, i.e. Medicare, Medicaid and / or Non-Governmental, i.e. Commercial: healthcare revenue cycle functions, PFS operations, regulations and reimbursement methodology, denials management, payor technical denial appeals and a proven track record of successful performance within the Revenue Cycle Required 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. Ability to: establish a climate to achieve optimal performance levels and maintain a cohesive work team work efficiently under pressure and deal effectively with constant change operate a computer and related applications apply appropriate supervisory, management and leadership techniques in an operational setting work independently and take initiative demonstrate a commitment to continuous learning deal effectively with difficult people and/or difficult situation willingly accept responsibility and/or delegate responsibility set priorities and use good judgment for self and staff Required Minimum License(s) and Certification(s)
Additional Licenses and Certifications
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