Accts Rec & Denial Spec 1 / PA Third Party Follow Up

Hartford HealthCare•Farmington, CT

About The Position

Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 or HCFA1500 (bills), monitor responses from clearinghouse, review EFT (Electronic File Transmission) responses, respond on underpayments or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue cycle activities associated with outstanding insurance balances across all Hartford HealthCare hospitals, medical group and homecare. These duties include the managing of the day-to-day work queue inflow, dashboard monitoring, weekly aging’s, Work in Progress (WIP), account activity assignment, and internal department collaboration with daily productivity and quality standards that are tracked and monitored. Keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or commercial payers. Assists the organization to comply with all federal/state guidelines. Responsible to meet quality standards, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives which is not limited to HHC receiving the appropriate payment.

Requirements

Minimum: High school diploma, GED or equivalent
Minimum: 1 -2 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience
Excellent analytical and problem-solving skills
Skill in problem solving
Skill in time management
Ability to work efficiently under pressure
Ability to operate a computer and related applications such as Word, Excel, PowerPoint, etc.
Ability to work independently and take initiative
Ability to demonstrate a commitment to continuous learning and to operationalize that learning
Ability to deal effectively with constant changes and be a change agent
Ability to deal effectively with difficult people and/or difficult situations
Ability to willingly accept responsibility
Ability to set priorities and use good judgment for self
Ability to exercise independent judgment in unusual or stressful situations
Ability to establish and maintain effective working relationships.

Nice To Haves

Preferred: Associate’s degree in health care administration, business management or finance.
Preferred: 3+ years of medical billing and/or accounts receivables experience in a large facility or professional healthcare revenue cycle setting.
Preferred: American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification
Epic experience and working knowledge of Hospital and Professional billing modules preferred

Responsibilities

Functions as a member of the team that is responsible for the timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials.
Follows up directly with commercial and governmental payors to resolve denials, underpayments, no pays, payor rejections, claim edits and credit balances.
Reconciles outstanding balances ensuring all efforts have been exhausted (calling insurance companies, using the payer web pages, utilizing payer chat function) in resolving issues with payers prior to write-off.
Responds to insurance companies inquires for follow up on issues to ensure payment.
Meets productivity and quality performance expectations as provided by leadership.
Documents clear and concise notes in the EPIC system regarding claim status and any actions taken on an account.
Works with leadership to identify, trend and address root causes of issues in the AR. Keeps leadership informed of any issues or trends.
Communicates with peers, management and internal colleagues to facilitate the flow of information. Demonstrates H3W Leadership Behaviors.
Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organization’s objectives.
Assumes responsibility for self-improvement in collaboration with superior.
Maintains effective positive customer service, ensuring the needs are met.
Performs other duties as assigned