Account Resolution Representative Senior

Children's Hospital and Health System•West Allis, WI

About The Position

Responsible for the review, follow-up and collection of Government, HMO, and Commercial insurance accounts receivable. This role performs comprehensive follow-up activities that facilitates cash collections and ensures that claims are paid according to contract or at the accepted reimbursement dollar amount. The Sr. Account Resolution Rep is generally responsible for inpatient, surgical, and oncology accounts but may be called on to assist with other patient claims.

Requirements

High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) Required
2+ years experience of claims follow up , HCFAs and/or UB-04’s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOB’s Required
Working knowledge of medical terminology, ICD-9, CPT and HCPCS level II codes Required
Excellent verbal and written communication skills.
Strong analytical skills and ability to perform non-complex arithmetic calculations when determining contractual allowances.
Ability to work independently with minimal supervision.
Proficient in Microsoft Office applications and technology skills required to perform duties.
The ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, patients, physicians, management, staff, and other customers. Required for All Jobs

Nice To Haves

General pediatric and/or pediatric subspecialty experience Preferred
Prior EPIC, QSI or IDX experience Preferred
Bilingual skills a plus.
Professional certification in claims processing through HFMA or AHAAM is desired.

Responsibilities

Utilizes hospital computer billing system(s) to follow-up on unpaid, underpaid, and credit balance accounts.
Performs various collection actions including contacting patients/parents, insurance companies, correcting and resubmitting claims and filing appeals in order to achieve claim resolution.
Investigates credit balances to include research of EOB’s and verification of accurate contractual discounts.
Review written requests for refunds from insurance companies and other payers to protect CHW’s financial interests and completes appropriate paperwork for management authorization.
Maintains current knowledge of managed care payer contracts and third party payer billing/ reimbursement policies for all lines of business (Government, HMO and Commercial).
Utilizes payer websites and electronic eligibility clearinghouses to verify the accuracy of patient insurance information and check claims payment status.
Files online and/or paper appeals as necessary to obtain proper payment on claims.
Analyzes payer errors and/or denials to identify trends.
Keeps Lead and Management informed of issues that impact cash flow.
Prepares month-end contractual reports for the Finance Department and other statistical reports as needed.
Handles outside audits and edits of charges.
Reviews and recommends write off of claims to management as appropriate.
Maintains productivity and quality standards as set by management.
Works with Lead to resolve charging and claim issues.