Accounts Receivable Representative I

Hospital for Special Surgery•Ronkonkoma, NY

23h•Onsite

About The Position

How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let’s talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Requirements

Minimum one (1) year of experience in hospital and/or professional billing, insurance follow-up, customer service, patient financial services, cash posting, or a related healthcare environment.
High School Diploma or equivalent (G.E.D.), may include specialized or vocational courses.
Insurance follow-up and account resolution
Hospital Billing (HB) and/or Professional Billing (PB)
Basic denial management
Ability to navigate Epic Resolute Hospital Billing and/or Professional Billing workqueues, account activity, claim history, and follow-up documentation functions.
Microsoft Office Suite
Customer service
Effective verbal and written communication
Attention to detail
Organization and time management
Ability to manage assigned inventory and prioritize workload

Nice To Haves

Previous Hospital Billing (HB) and/or Professional Billing (PB) follow-up experience preferred.
Experience with: Hospital billing and/or Professional billing and insurance follow-up, Basic denial management, Epic Resolute Hospital Billing and/or Professional Billing, Commercial, Medicare, Medicaid, Workers' Compensation, No-Fault, and Managed Care reimbursement, Microsoft Office Suite with emphasis in Excel
Strong customer service, communication, organizational skills, and attention to detail
Ability to meet productivity and quality standards within a revenue cycle environment
Understanding of basic revenue cycle functions.
Knowledge of claim lifecycle from billing through reimbursement.
Basic understanding of CPT, HCPCS, ICD-10, and insurance terminology.
Associate’s degree in healthcare administration, Business Administration, Health Information Management, or related field preferred.
Certified Revenue Cycle Representative (CRCR)
Certified Professional Biller (CPB)
Other healthcare revenue cycle certifications preferred.
Epic Resolute Hospital Billing and/or Professional Billing experience
Knowledge of payer reimbursement methodologies
Insurance follow-up and basic denial resolution
Commercial, Medicare, Medicaid, Workers' Compensation, No-Fault, and Managed Care follow-up
Ability to identify routine claim issues and escalate complex reimbursement concerns appropriately

Responsibilities

Resolves Payor Issues: Reviews assigned Hospital Billing (HB) and/or Professional Billing (PB) workqueues for routine unpaid or pending insurance claims. Contacts insurance carriers regarding claim status, missing information, and routine reimbursement issues. Research payer responses and follows established departmental workflows to facilitate timely reimbursement. Escalates complex reimbursement issues requiring additional review.
Supports Claim Resolution: Reviews routine denial information and identifies appropriate next steps. Assists with corrected claims, reconsiderations, appeals, and supporting documentation as directed. Coordinates with internal departments to obtain information needed for claim resolution. Supports timely resolution of assigned accounts.
Maintains Documentation & Account Information: Maintains complete, accurate, and timely account documentation. Documents payer communications, account activity, and follow-up actions. Updates claim history to support continued account resolution. Maintains documentation in accordance with departmental standards.
Coordinates Interdepartmental Communication: Communicates with Coding, HIM, Patient Access, Billing, Cash Posting, and other departments regarding routine claim issues. Routes accounts requiring additional review with supporting documentation. Monitors routed accounts and follows up as appropriate. Escalates unresolved issues when departmental turnaround times are exceeded.
Productivity & Operational Performance: Achieves established productivity, quality, aging, and inventory management benchmarks. Maintains assigned inventory in accordance with departmental service level expectations. Supports departmental accounts receivable reduction and cash collection goals. Participates in departmental process improvement initiatives.
Compliance: Ensures follow-up activities comply with payer regulations, hospital policies, and departmental procedures. Protects confidential patient and financial information in accordance with HIPAA requirements. Maintains current knowledge of payer policies, Epic workflow updates, and departmental procedures.
Team Collaboration: Participates in departmental meetings, huddles, training sessions, and quality reviews. Communicates effectively with peers and internal departments. Demonstrates flexibility with changing work assignments and departmental priorities. Maintains satisfactory attendance and punctuality.