Accts Rec & Denial Spec 3 / PA Non Medicare Billing

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 Electronic Fund Transmission (EFT) 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. Support and perform high level AR & Denial Specialist tasks to improve operations and problem solve by developing solutions after analyzing data. Maintains a high-level understanding of the operational aspects of the entire revenue cycle as well as the appropriate measures to take in resolving claim issues with payers. This position is responsible for researching insurance company issues, such as network problems, work comp claims, and a variety of special projects. 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 ensure high quality, 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: 3 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience
Knowledge, Skills and Ability Requirements · 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

Preferred: Associate’s degree in health care administration, business management or finance.
Preferred: 4+ 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 Resolute Hospital and Professional billing modules preferred

Responsibilities

Functions as a high-level 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.
When a claim is denied; A. Takes appropriate action for payment resolution; documents all activity in accordance with standard work B. Initiates, updates, resolves denials and payment variances and takes action to resolve account including drafting and submitting appeals, identifying specific reason for underpayments, denials and cause of payment delays. Maximizes insurance reimbursement timely with commercial and governmental payers C. Resolves denials based on contract and/or fee schedule. D. Performs due diligence in reconciling outstanding balances ensuring all efforts have been exhausted in resolving issues with payers prior to write-off. E. Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with standard work F. Prepares research and documentation in preparation for meetings with provider reps that will assist in resolution of payer specific issues. G. Works with leadership to identify, trend and address root causes of issues in the AR. H. Improves quality and productivity by identifying opportunities and assisting with workflow changes I. Assists in development of standard work to improve accuracy and understanding of processes. J. Consistently exceeds productivity and quality performance expectations.
Effectively and continually communicates with peers, management and customers 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.
Maintain effective positive customer service, ensuring the needs are met and educating staff on the importance of quality customer service.
Provides support for other ad hoc analyses and projects as needed
Provide team support during team vacations and unexpected absence
Training support for onboarding of new colleagues.
Functions as Daily Huddle Leader
Performs other duties as assigned
Assist supervisor with the tracking and monitoring of accounts receivables engagements with small balance, out of state Medicaid and credit vendors as needed.