Lead Accounts Receivable Rep-Tri-State Ambulance

Gundersen Health System • La Crosse, WI

4d • Onsite

About The Position

Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today. Scheduled Weekly Hours: 40 The Lead Accounts Receivable Representative plays a lead role in the overall daily workflow of their specific area including but not limited to daily processes such as answering incoming phone calls, acting as a resource for other Accounts Receivable Representatives, and auditing as well as providing training and support to other Accounts Receivable Representatives. In addition to the Accounts Receivable Representative duties, the Lead Accounts Receivable Representative will oversee the daily work processes for their specific area, which may include the following: What will you be doing? Collaborate with other departments to ensure smooth work processes (IS, Finance). Train new Accounts Receivable Representatives and provide continuous support as a resource outside of training Assist in personnel issues affecting Accounts Receivable Representatives. Attend and participate in all interviews for Accounts Receivable Representatives. Collaborate in the completion of all annual reviews for Accounts Receivable Representatives. Works collaboratively with payors, patients, and internal contacts to identify and rectify billing issues resulting in reimbursement and final disposition of claims. Verifies accuracy of payment for correct reimbursement. Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payor communications, federal registrars and contractual guidelines to ensure compliance. Is familiar with government and commercial Web Sites and can research and interpret them effectively. Works with our internal and external customers to maintain data integrity within patient accounting systems. Works closely with Customer Service, Patient Relations, Risk Management, and Provider Medical Management to provide direction with complicated account inquiries to provide accurate and timely responses to patients resulting in increased overall patient satisfaction. Uses CWS to view patient preferences to communicate with patients including those cared for by Behavioral Health. Performs complex guarantor account reviews on all financial classes including credit balances. Investigates and appeals denials from Third Party Payors by verifying accuracy and compliance of claim submission. Performs necessary error corrections and/or initiates a refund request to rectify the guarantor account. Documents all activities/actions taken on an individual patient account within the billing system. Must be familiar with appropriate regulatory and contractual guidelines including HIPAA, in order to review and make corrections as appropriate. Effectively communicates and educates patients on their financial responsibilities to the organization by giving estimates on services, setting up payment arrangements and negotiating settlements on accounts under direction of Supervisor/Manager/Director. This would include the guidelines for payments and self pay balances, along with the insurance process and statements they will receive. Actively participates in analysis of work processes and providers feedback to the PBS Managers and PBS System Trainers to assist in enhancing overall patient satisfaction and work process improvements. Participates actively in department meetings, and assumes additional responsibilities and special projects as assigned. Determines appropriate insurance eligibility and rebills claims with new information. Contacts and works directly with patients when necessary. Identifies and routes to appropriate staff for solving Charge Master Issues. Requests refund checks for overpayments to third party payor or patient if appropriate. Notifies insurance company to recoup payment if required by contract. Identifies issues with ERN files. Involves PBS Systems, Payment Posting and appropriate staff to resolve and problem solve. Involves IS when necessary. Provides appropriate information and feedback. Adheres to regular and predictable attendance.

Requirements

• High School Diploma or equivalency
• Successful completion of defined core competency testing for Accounts Receivable Representatives. (must be completed within first 6 months of hire if not already completed)
• 3-4 years of Accounts Receivable Representative experience.

Nice To Haves

• 1 year experience in a healthcare setting with claims billing Third Party Payor.

Responsibilities

• Collaborate with other departments to ensure smooth work processes (IS, Finance).
• Train new Accounts Receivable Representatives and provide continuous support as a resource outside of training
• Assist in personnel issues affecting Accounts Receivable Representatives.
• Attend and participate in all interviews for Accounts Receivable Representatives.
• Collaborate in the completion of all annual reviews for Accounts Receivable Representatives.
• Works collaboratively with payors, patients, and internal contacts to identify and rectify billing issues resulting in reimbursement and final disposition of claims.
• Verifies accuracy of payment for correct reimbursement.
• Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payor communications, federal registrars and contractual guidelines to ensure compliance.
• Is familiar with government and commercial Web Sites and can research and interpret them effectively.
• Works with our internal and external customers to maintain data integrity within patient accounting systems.
• Works closely with Customer Service, Patient Relations, Risk Management, and Provider Medical Management to provide direction with complicated account inquiries to provide accurate and timely responses to patients resulting in increased overall patient satisfaction.
• Uses CWS to view patient preferences to communicate with patients including those cared for by Behavioral Health.
• Performs complex guarantor account reviews on all financial classes including credit balances.
• Investigates and appeals denials from Third Party Payors by verifying accuracy and compliance of claim submission.
• Performs necessary error corrections and/or initiates a refund request to rectify the guarantor account.
• Documents all activities/actions taken on an individual patient account within the billing system.
• Must be familiar with appropriate regulatory and contractual guidelines including HIPAA, in order to review and make corrections as appropriate.
• Effectively communicates and educates patients on their financial responsibilities to the organization by giving estimates on services, setting up payment arrangements and negotiating settlements on accounts under direction of Supervisor/Manager/Director.
• Actively participates in analysis of work processes and providers feedback to the PBS Managers and PBS System Trainers to assist in enhancing overall patient satisfaction and work process improvements.
• Participates actively in department meetings, and assumes additional responsibilities and special projects as assigned.
• Determines appropriate insurance eligibility and rebills claims with new information.
• Contacts and works directly with patients when necessary.
• Identifies and routes to appropriate staff for solving Charge Master Issues.
• Requests refund checks for overpayments to third party payor or patient if appropriate.
• Notifies insurance company to recoup payment if required by contract.
• Identifies issues with ERN files.
• Involves PBS Systems, Payment Posting and appropriate staff to resolve and problem solve.
• Involves IS when necessary.
• Provides appropriate information and feedback.
• Adheres to regular and predictable attendance.

Benefits

• Competitive Benefits: We offer a comprehensive package including medical, dental, pet insurance, and a generous retirement contribution.
• Work-Life Balance: We prioritize your well-being with a 24/7 Employee Assistance Program, generous PTO, and paid holidays.
• Diversity, Equity & Inclusion: We foster a welcoming environment with an inclusive celebration program, Unconscious Bias Training, and Patient Care resources.
• Additional Perks: Enjoy an 18% discount on your Verizon data plan and a 20% discount on Gundersen services not covered by insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED