Accounts Receivable Representative - US Healthcare

Amazing opportunity to work with one of the largest hospitals in the United States. We are looking for energetic goal driven individuals that want the potential to excel and climb the ladder of success.

If you’re looking for long term employment with the chance to quickly prove yourself and be promoted, then send us your resume. With multiple positions available, you can quickly be promoted to team lead, trainer or even operations manager. 

This position requires detailed analysis and critical thinking to determine what is necessary to ensure timely and efficient resolution of an account Promotes revenue integrity and accurate reimbursement for the organization by enduring timely and accurate billing and collection of accounts Maintains and monitors integrity of the claim development and submission process. Acts as a liaison between patients, providers, and payers for all post care matters related to account resolution The PFS Representative maintains an understanding of federal and state regulations, as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries to promote compliant claims for governmental claims Maintains third party payer relationships, including responding to inquiries, complaints, and other correspondence Additionally, this individual must follow departmental productivity and quality control measures that support the organization’s operational goals All PFS representatives will participate in process improvement and cross training activities on an ongoing basis Will be assigned to support one or more of the following departments:

Billing Follow UpCash ApplicationsCredits DepartmentCustomer Service

General Duties & Responsibilities:

Follows best practices in all patient financial services activitiesUtilizes tools and work queues to identify and prioritize workDemonstrates teamwork and integrity in all work related activities to continually improve services and engage in process improvement activitiesdocuments all patient accounts activities concisely, including future steps needed for resolutionEffectively handles all communications, including telephone and email, from payers and departments within the business officeComplies with state and federal regulations, accreditation/compliance requirements, and the Hospital’s policies, including those regarding fraud and abuse, confidentiality, and HIPAAPerforms billing and follow up activities for claimsWorks daily electronic billing file and submits insurance claims to third party payersdocuments billing activity on the patient accounts ensures Hospital compliance with all state and federal billing regulations and reports any suspected compliance issues to the appropriate supervisorReviews daily edit reports from the billing systemPrepares and submits manual insurance claims to third party payers who do not accept electronic claims or who require special handlingContacts third party payers to determine reasons for outstanding claims and communications with payers to facilitate timely payment of claims Investigates any overpayments and underpayments and Medicare bad debt reporting policies in compliance with the Centers for Medicare Medicaid Services (CMS) guidelines

Customer Service Duties & Responsibilities:

Serves as the hospital’s primary contact for all patient billing inquiries Accepts inbound phone calls from patients, physician offices, and insurance carriersCollects patient payments and follows levels of authority for posting adjustments, refunds, and contractual allowances Assist patients in understanding billing statements to ensure swift resolutionReviews and processes financial assistance requests, documents approval/denials

Cash Application Duties & Responsibilities:

Accurately post payments and adjustment, resolve credit balances, and monitor trends and compile reports for leadership, among other dutiesPrepares, posts, and processes payment batches posts denials, contractual adjustments, and guarantor payments within payment batches and ensures all payments batches are balancedInvestigates the source of unidentified payments to ensure they are applied to appropriate accountsAnalyzes EOB information, including co pays, deductibles, co insurance, contractual adjustments, denials, and more to verify accuracy of patient balancesReconciles EOB’s to make necessary adjustments

Credit Balance Duties & Responsibilities:

Determines reason for credit balances and is responsible for accurate completion and resolution of potential credit balances for health plan payers and patients/guarantorsIdentifies and examines underpayments/unapplied credits to determine if additional payment can be pursued, or if refund is necessary follows up with payers and patients as appropriateGenerates refund requests and routes the resolution to accounts payable for patients and third party payers refunds overpayments and/or transfers payments to the appropriate account/accounts Responsible for correcting errors in the calculation and posting of insurance contractual adjustments

Competencies:

Hospital billing and reimbursementThird party contractsFederal and state billing regulationsDetailed knowledge of CMS billing guidelines and regulations for all governmental payersExcellent critical thinking and analytical skillsSuperior communication, organizational, and analytical skillsProficient organizational skills and attention to detailStrong writing and communication skillsStrong interpersonal and customer service skillsAbility to multitask and work in a fast paced environmentAbility to comply with procedural guidelines and maintain confidentialityBasic knowledge of insurance processing terminologyAbility to prioritize tasks, carry out assignments independently and within a team, and to practice good judgmentDemonstrates a commitment to organizational values by displaying a professional attitude and appropriate conduct in all situations

Education:

Bachelor's DegreeMajor in Medical field or equivalent preferred but not required

Experience:

Two years of experience in US healthcare revenue cycleProficiency in Microsoft computer programs preferredKnowledge of medical terminologies preferredExperience with Epic/Sorian preferred

Schedule:

Central Time