Account Resolution Rep I

Wellstar Health System•VIRTUAL-GA, GA

22h

About The Position

The Account Resolution Rep I collects and resolves payments from insurance companies by working with assigned payers and following applicable policies and procedures. The role handles denial appeals, researches rejected or denied claims, assesses insurance payment accuracy and completeness, and checks payer claim processing against contracts. It works with clinical staff when needed to follow up on and appeal denials, submits required documentation to government and third-party payers, documents payer contacts in the appropriate software, and ensures claims are crossed over to secondary insurance. The representative prepares and maintains reports, identifies and reports ongoing departmental or contract problems, communicates contract issues and delayed adjudication to management, and offers process-improvement feedback. The position is accountable for meeting productivity and quality standards, including successful appeals and tracking root causes. It also contributes to team goals, participates in collaboration and cross-training, communicates relevant changes, protects patient privacy, and works professionally with patients, payers, healthcare staff, and internal departments. The role follows departmental procedures and regulatory requirements, uses assigned computer hardware, software, and office equipment, reports technical problems, and may participate in software testing. Other duties may be assigned.

Requirements

High school diploma or equivalent.
Ability to perform mathematical calculations and demonstrate high-level problem-solving, analytical, and investigative skills.
Excellent oral and written communication and comprehension skills when dealing with patients, families, the public, coworkers, and professional offices.
Basic experience and knowledge of PC applications.
Attention to detail, good organizational skills, and ability to work independently.
Strong time-management skills and ability to learn quickly, meet ongoing timelines, and manage multiple priorities and a heavy workload in a high-stress environment.
Flexibility to perform other tasks as needed in an active environment with changing work needs.
Ability and willingness to demonstrate behaviors consistent with excellent service principles.
Ability and willingness to maintain competency required for the job title and assigned unit or area.
Ability and willingness to demonstrate behaviors consistent with performance-improvement standards and organizational values, including efficiency and financial responsibility, safety, partnership and service, teamwork, compassion, integrity, trust, and respect.

Nice To Haves

At least 2 years of collection experience (preferred).

Responsibilities

Collect and resolve payments from insurance companies using assigned payer procedures and policies.
Process denial appeals by receiving, assessing, documenting, tracking, responding to, and resolving appeals in a timely manner.
Research rejected or denied claims, analyze payment accuracy and completeness, and review payer processing for compliance with contracts.
Work with clinical staff as needed to follow up on and appeal denials.
Prepare, maintain, assist with, and submit required reports.
Report ongoing problems related to health system departments or contracts to the Team Manager or Team Lead.
Provide management with process-improvement feedback about facility, Patient Access, Case Management, HIM, Billing, and payer issues found during account review.
Appeal denials according to departmental procedures, using correct grammar and spelling.
Identify contract issues involving denials or delayed adjudication and communicate them to the Manager.
Transmit required documentation to government and third-party payers to resolve payments.
Document all payer contact in the appropriate software application.
Ensure claims are crossed over to secondary insurance and report delays in unbilled secondary claims to the Lead.
Meet current productivity standards for addressing and resolving accounts.
Meet current quality standards by identifying and tracking root causes, appealing denied accounts, and trending issues.
Contribute to team efforts to achieve the department's accounts-receivable goal.
Identify system and process improvement opportunities and raise them in team meetings.
Become cross-trained and fill in for other staff as assigned.
Encourage team collaboration and unity, and communicate procedural changes and relevant information to peers and management.
Communicate professionally with patients, families, third-party payers, physicians and their staff, coworkers, management, and internal customers.
Protect patient privacy and confidentiality.
Maintain professional relationships and convey relevant information to healthcare team members and applicable referral agencies.
Follow departmental guidelines for lunches, breaks, time-off requests, and shift assignments.
Operate office equipment and machinery and use ergonomic workstations, equipment, and supplies.
Follow JCAHO and other regulatory agencies' rules and procedures.
Use assigned mainframe menus and pathways, and report software application problems to the appropriate source.
Use assigned computer hardware and report hardware problems to the appropriate source.
Participate in testing assigned software applications, including verification of field integrity when needed.
Perform other duties and responsibilities as assigned.