Accts Rec & Denial Spec 2 / PA Third Party Follow Up

Hartford Healthcare•Farmington, CT

About The Position

This position is within the Hartford HealthCare System Support Office, which recognizes the work of employees whose responsibilities evolve to support the system as a whole. The role focuses on ensuring timely and accurate submission of claims, monitoring responses, and resolving issues related to underpayments, overpayments, and claim denials. The specialist will analyze claim adjustment and remittance advice codes, manage daily work queues, monitor dashboards, and collaborate with internal departments to meet productivity and quality standards. This role requires a high-level understanding of the entire revenue cycle and the ability to research insurance company issues, special projects, and maintain compliance with regulations. The ultimate goal is to ensure Hartford HealthCare receives appropriate payment for services rendered.

Requirements

High school diploma, GED or equivalent.
3 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience.
Epic experience and working knowledge of Resolute Hospital and Professional billing modules preferred.
Understanding of medical and insurance terminology, facility and professional billing/reimbursement practices.
Familiar with CPT, revenue codes and ICD10 codes.
Excellent analytical and problem solving skills.
Excellent communication skills both written and verbal and interpersonal skills.
Knowledge of state and federal regulations as they pertain to billing processes and procedures.
Knowledge of insurance claim processing and third party reimbursement.
Knowledge and understanding of negotiated agreements.
Demonstrated leadership in establishing and achieving goals.
Ability to communicate effectively both orally and in writing, strong computer and math skills required.
Skill in problem solving in a variety of settings.
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 and/or delegate responsibility.
Ability to set priorities and use good judgment for self and peers.
Ability to exercise independent judgment in unusual or stressful situations.
Ability to establish and maintain effective working relationships.

Nice To Haves

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

Responsibilities

Take appropriate action for payment resolution when a claim is denied, documenting all activity.
Initiate, update, and resolve denials and payment variances.
Draft and submit appeals, identify specific reasons for underpayments and denials, and determine the cause of payment delays.
Maximize insurance reimbursement timely with commercial and governmental payers.
Resolve denials based on contract and/or fee schedule.
Perform due diligence in reconciling outstanding balances, ensuring all efforts have been exhausted before write-off.
Leverage internal and external systems to analyze patient accounting information and take appropriate action for payment resolution.
Prepare research and documentation for meetings with provider representatives to resolve payer-specific issues.
Work with leadership to identify, trend, and address root causes of issues in the Accounts Receivable.
Improve quality and productivity by identifying opportunities and assisting with workflow changes.
Assist in the development of standard work to improve accuracy and understanding of processes.
Consistently exceed productivity and quality performance expectations.
Effectively and continually communicate with peers, management, and customers.
Demonstrate H3W Leadership Behaviors.
Actively seek opportunities to model teamwork through collaboration.
Assume responsibility for self-improvement in collaboration with superior.
Maintain effective positive customer service and educate staff on its importance.
Provide support for other ad hoc analyses and projects as needed.
Provide team support during vacations and unexpected absences.
Provide training support for onboarding new colleagues.
Functions as Daily Huddle Leader.
Perform other duties as assigned.