Acct Resolution Rep II

Facility: VIRTUAL-GA

Job Summary:

Under 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. This includes 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, ensuring eligible accounts are reviewed, appealed, escalated, or adjusted within the designated payer time frames and documented appropriately in the patient accounting system. This role requires data analysis, trending analysis, and educational capabilities regarding payor and revenue cycle business-related processes. A versatile and well-developed actionable understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation, and provider/payor appeal requirements is essential. A strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word, and Outlook are necessary to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable trending and findings. The core focus of this position is to ensure that accounts are brought to final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development, and conformity to defined Policies and Procedures.

Core Responsibilities and Essential Functions:

1. Maintain a working knowledge and perform assigned duties in compliance with all departmental billing and follow-up policies, procedures, processes, and functions.
2. Respond appropriately to inquiries from 3rd parties, insurance providers, and patients regarding accounts, collection issues, and hospital policies to ensure a minimal Accounts Receivables inventory.
3. Collect and resolve payments from insurance companies by working with assigned payers and utilizing established policies and procedures.
4. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract.
5. Successfully appeal denied accounts and avoid excessive deferred accounts.
6. Demonstrate effective collaboration skills and support to the follow-up staff in the performance of their daily functions.
7. Review account receivables while evaluating trends and tracking recovery efforts by utilizing various departmental tools.
8. Assist staff by providing direction and guidance, creating a team environment through training, recognition, and education.
9. Provide assistance with staff training and oversight to ensure that implemented policies and procedures are being followed.
10. Monitor progress for assigned workflow on a daily basis and provide feedback to leadership regarding success and obstacles to claim resolution.
11. Maintain and reflect a positive team attitude regarding any special projects or policies that are implemented.
12. Resolve complaints and misunderstandings in a timely and appropriate manner.
13. Maintain a working knowledge of WellStar policies and procedures.
14. Maintain effective communications with legal collection groups, the WellStar Compliance department, and other agencies.
15. Perform other duties as assigned.

Required Minimum Education:

• High School Diploma or GED

Required Minimum Experience:

Minimum 1 year experience as an Account Follow-up Representative I or a minimum of two (2) years in hospital patient financial services or related area. Must have a thorough understanding of Governmental (Medicare, Medicaid) and Non-Governmental (Commercial) healthcare revenue cycle functions, PFS operations, regulations, and reimbursement methodology.

Required Minimum Skills:

Strong interpersonal, mathematical, analytical, computer, problem-solving, and writing skills. Must be comfortable interacting with insurance providers, physicians, and leadership. Competent with MS Word, PowerPoint, and MS Excel is required.