|Date Posted:||Apr 3|
TITLE: Accounts Receivables Representative, Sr.
LOCATION: Houston TX 77021
SALARY or RATE: $15-17/hr
URGENCY: Start April 1st
• 5 years revenue cycle experience
• Strong collections experience
• 2 years related healthcare experience
• General knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations.
• The knowledge of how managed care plans work and the requirements for insurance coverage and benefits.
• Ability to communicate effectively both oral and written, good interpersonal skills; decision-making skills; professional courtesy; the ability to operate a PC and general office equipment.
• Must have a strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations.
• The position of Senior Account Representative provides collections follow-up on all assigned Accounts Receivable accounts to ensure continuity of cash flow and the collection of every collectible dollar with efficient account resolution.
• It is the responsibility of the Senior Account Representative to ensure reimbursement according to all contractual commitments as well as government regulations. This position may also assist with the application process of charity or payment plans for guarantors and families who may need this assistance.
• In addition, this position may be responsible for appealing underpayments and denials within each payors contractual guidelines as well as government timelines.
• The Senior Account Representative will work closely with Admissions, Billing, Medical Records, Care Management, and Contracting in order to retrieve information supporting appeals and communicating denial trends.
• Senior Account Representative will supplement training and mentoring new employees, and may be asked to work on special projects for management.
Bachelors Degree in business preferred
Responsibility A: Initiates timely contact with guarantors/third party payors to follow-up on outstanding receivables.
• Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures.
• Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes.
• Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Ensures that all accounts associated with that guarantor and payor relationship are resolved.
• Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance.
• Refers problem accounts to team lead or manager prior to account becoming 60 days old if unable to resolve the account. Documents the issues in detail and refers to team lead or manager with a recommendation of action needed. Provides continual follow-up by working with team lead or manager to resolve the issue.
Responsibility B: Initiates contact with third party payors to follow-up on outstanding receivables that have been underpaid or denied for payment.
• Researches the denied claim to determine reason for the denial by contacting the payor and reviewing the Explanation of Benefits (EOB) or Remittance and Status Report (R&S).
• Determines appropriate level of appeal to pursue based on research. Follow-up may require working with team lead and/or manager in conjunction with Admitting, Billing, Medical Records, Care Management, and Contracting to ensure appropriate documentation is received to support appeal.
• Composes the appropriate appeal letter identifying reason for denial and explanation as to why Texas Children’s Hospital is seeking appeal of denial. Ensure appropriate payor guidelines and timelines are followed for appeal.
• Escalates appeals to team lead or manager to review if there is a strong supporting argument that it should be escalated at payor level. If additional appeals are not warranted, recommends the appropriate action to resolve the account.
• Documents every collection effort including letters and phone calls prior to releasing the account to the next responsible party or submitting for adjustment. Documentation should specifically explain the cause of the denial or adjustment or why the balance is now moving to the next responsible party.
Responsibility C: Maintains Accounts Receivable by following established Departmental Policy & Procedures, Workflows, and Departmental Goals.
• Maintains assigned accounts receivable at or below specified departmental targets and goals.
• Follows established departmental workflows to ensure that all accounts are being worked in a timely manner.
• Uses and refers to managed care manuals, the payor contract matrix, letters of agreement, and any other agreements to determine that appropriate discounts are posted to the accounts.
• Shares responsibility for the overall success of the team and works directly with the patient account reps to ensure that departmental goals and objectives are being met.
• Maintains active accounts on assigned workqueue(s) at the expected level.
Responsibility D: Actively participates in special assignments, programs, or improvement initiatives with successful outcomes.
• Participates in the special assignments, programs, or initiatives relating to departmental performance such as special training in new collection techniques, new laws or payor in-services.
• Trends and reports denials or problem issues with payors, processes, or policies that will aide in improving the cash performance or accounts receivable management to team lead or manager.
• Participates in payor specific meetings when needed to help resolve issues and improve communications and processes.
• Assists other staff members with difficult or escalated account issues
. Responsibility E: Provides supplemental training to employees on departmental policies and procedures and appropriate collection techniques.
• Provides supplemental training to new employees which may include evaluating accounts, accessing and reviewing contract matrix, documentation requirements, escalation process and overall daily routine.
• Assists with questions from other staff members.
• Brings ideas and issues to management regarding an employee’s ability to perform assigned job duties.
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