Account Resolution Rep I

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Duties and Responsibilities

• Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures.
• Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.
• Prepare, maintain, assist with, and submit reports as required.
• Appropriately report on-going problems specific to health system departments, and/or contracts to Team Manager or Team Lead.
• Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for resolution.
• Appeal in accordance with methodology in departmental policy and procedure including using correct grammar and spelling.
• Identify contract issues related to denials and delayed adjudication; communicate those issues to Manager.
• Transmit required documentation to Government and third-party payers for the purpose of resolving payments.
• Ensure all payer contact is fully documented in the appropriate software application.
• Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to your Lead.
• Consistently meet the current productivity standards in addressing and resolving accounts.
• Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues.

Teamwork

• Provide individual contribution to the overall team effort of achieving the department AR goal
• Identify opportunities for system and process improvement and submit in team meetings
• Become cross-trained and fill in for other staff as assigned
• Particpate and encourage team collaboration and unity.
• Initiate communication with peers about changes and procedures, convey new relevant information to other team members and management.

Administrative

• Professional Communication
• Assure patient privacy and confidentiality as appropriate or required
• Communicate in a professional manner with patients, their families and representatives from third party payor organizations, physicians and their staff, co-workers and management.
• Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies
• Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives
• Department Methods/Procedures/Operations
• Follow department guidelines for lunch, breaks, requesting time off, and shift assignments
• Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies
• Follow JCAHO and outside regulatory agencies’ mandated rules and procedures
• Utilize assigned menus and pathways in the mainframe system. Report software application problems to the appropriate source.
• Utilize assigned computer hardware. Report hardware problems to the appropriate source.
• Participate in the testing for assigned software applications, including verification of field integrity when needed.
• Perform other duties and responsibilities as assigned

Qualifications

• Required Minimum Education
• High school diploma Required or equivalent Required
• Required Minimum Experience
• Minimum 2 years collection experience Preferred
• Required Minimum Skills
• Ability to perform mathematical calculations with High-level problem solving, analytical, and investigational skills
• Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices including oral and written comprehension and expression
• Basic experience and knowledge of PC applications
• Detail-oriented, good organizational skills, and ability to be self-directed
• Strong time management skills; Ability to learn quickly and meet continuous timelines, managing multiple priorities and a heavy workload in a high-stress atmosphere
• Demonstrate flexibility to perform other tasks as needed in an active work environment with changing work needs
• Ability and willingness to exhibit behaviors consistent with principles of excellent service
• Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment
• Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect)
• Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.