The Accounts Receivable Representative evaluates patient accounts and takes appropriate action pertaining to compliant billing and collections as necessary to assure timely payments or other disposition of patient accounts.
POSITION EXPECTATIONS & RESPONSIBILITIES:
* Assist in the increase of cash collection and the decrease of Accounts Receivables (AR) aging for designated plan(s) using effective and efficient collection techniques, including, but not limited to, the use of individual plan(s) escalation and/or appeal processes, patient and/or physician office contact.
* Able to understand and effectively interpret payer contracts, Remittance Advices (RA) and Explanation of Benefits (EOB) statements.
* Demonstrate a working knowledge of the medical health insurance benefits provided by assigned payer and consistently and accurately explain these to patients.
* Understand and follow processes needed to ensure clean claims are submitted timely using a third party claim editor system.
* Demonstrate knowledge of insurance and billing forms and the ability to investigate and resolve debit and credit account balances.
* Ensure all AR inquiries are responded to timely and appropriately. This includes inquiries related to denials and other "zero pay" transactions posted or not posted to the AR.
* Demonstrate basic knowledge of Microsoft Office with emphasis on the use of spreadsheets utilizing Excel.
* Knowledge of core hospital information systems relative to the Business Office, or the ability to learn the system
* Ensure timely follow up with the payers and/or patients to expedite payment of claims by effectively completing assigned work list as required by Supervisor and/or Manager.
* Perform consistent, assertive, efficient and timely follow-up on accounts as determined by Management. This includes responding timely to Project Specialist, Collector Analyst or Management regarding high dollar or complex accounts.
* Take appropriate action to resolve accounts, including, but not limited to, adjustments, changing schedules, changing FC, and moving money to appropriate buckets.
* Correct billing errors, edits, overlaps, etc., and submit claims electronically on a daily basis as required.
* Identify payor issues or trends and update Supervisor and/or Manager in a timely manner, providing concrete examples for Management to review.
* Review payment variances and remittances for resolution in an efficient and timely manner and process patient and/or insurance refunds.
* Consistently use TRAC variances (STAT, QUIC) to ensure appropriate action was taken when applicable.
* Document relevant activity in account notes in a clear and succinct manner while meeting QR standards as outlined in the department policy. This includes responding to QUIC request with clear documentation.
* Ensure compliance with payer billing guidelines and BRRH policies and procedures.
Minimum Education and/or Experience:
* High school diploma or general education degree (GED) and
* REQUIRED - Managed Care billing and collections experience, hospital billing and collections preferred.
* Incumbent may be required to perform emergency duty before, during and/or beyond normal work hours or days in the event of an emergency, crisis situation or disaster (man-made or natural) including evacuation sites.
* The person in this position will work in a smoke-free location, and is expected to adhere to all smoking restrictions.
* In the spirit of wellness for both our employees and patients, Employer has instituted a mandatory influenza prevention vaccination program. Current employees must receive the influenza prevention vaccination free of charge during the recognized flu season. As a condition of employment, new hires will be required to comply with all program rules. This is a mandatory program with the exception of documented medical or religious reasons for not receiving the vaccine. For further information on this progressive program, please contact Employer's Human Resources Department at 561-955-4075.