Patient Account Representative II - Collections - Full Time, Days

Texas Health Resources•Arlington, TX

1d•Hybrid

About The Position

Bring your passion to Texas Health so we are Better + Together. This role involves Receivables Management Collections, where you will verify the validity of account balances by researching, reviewing, and ensuring accuracy of payment and adjustment posting. You will take initiative to resolve accounts with and without supervision, and contact payors, networks, patients, employers, and other responsible parties to acquire timely and accurate/expected payment on assigned Accounts Receivable inventory. You will also take necessary steps needed to acquire and provide information needed for claims that have a zero payment, use payor-specific contract terms to resolve claims that are in process or have a payment variance, and refer claims that have a clinical denial to the Denials team for review and follow-up. Additionally, you will prepare appeal letters to dispute payor denials when appropriate, process and/or request rebills and other system actions as needed, understand and apply appropriate system discounts, and enter all communications regarding patient accounts in the host system. Accounts should be worked daily, with an emphasis on quality and resolution. Worklists should be stratified to ensure high dollar and/or aged accounts are the top priority, with the overall goal of resolving assigned inventory each week. You will work toward department goals and visions as an individual and as a team player, and meet and maintain quality and productivity performance metrics set forth by applicable leadership. You will also maintain proficiency in the host system. Furthermore, this role involves Receivables Management related to Financial Assistance. You will review financial assistance applications for completion prior to processing, determine if the application is complete, and if incomplete, request additional documents from the consumer by phone, mail, or email following HIPAA privacy guidelines. You will document the receipt of the application in the system and create a Case in the Financial Assistance Module, using the appropriate activity code in Epic to ensure productivity is accurate. You will review incoming applications received by mail, email or MyChart to determine if all required information was submitted. If incomplete, you will request additional documents from the consumer by phone, mail, or email following federal HIPAA regulations. You will process accounts timely, according to age and consumer request, using the appropriate activity code in Epic to ensure productivity is accurate. You will prepare and mail all approval/denial letters, prepare documents for scanning, and remove non-essential information from packets to protect consumers financial information. A significant portion of this role (50%) focuses on providing excellent service when dealing with payors, patients, employers, management, hospital staff, and other parties within and outside of THR. Communication should be clear, concise, and professional. Requests should be addressed timely, with the goal of completion within 3 days to avoid delinquency. Requests deemed as "escalated" should receive immediate attention. Another 20% of the role involves identifying and resolving problems related to payor contracts and reimbursement in a timely manner. You will inform the Business Operations Supervisor, Manager, and/or Payor Champion of any potential trends that might delay accurate payment (via appropriate mechanism - spreadsheet, email, etc...). You will also recommend accounts for placement with an outside collection/legal vendor when appropriate resolution is not obtained timely. The final 10% of the role focuses on compliance with THR policies and procedures, all applicable regulations with the operating systems, entity, and system policies and procedures. You will complete assigned tasks in a timely and effective manner and maintain up-to-date knowledge of local, state, and federal guidelines for communication and collections.

Requirements

H.S. Diploma or Equivalent Req
2 Years Healthcare Revenue Cycle Accounts Receivable Experience, healthcare or related organization. Req
Computer skills required in advanced word processing, spreadsheets, and graphic skills.
Ability to organize and coordinate workflow as well as meeting deadlines.
Must possess excellent communication, problem solving documentation, training and customer service skills.
Must be familiar with organizing, managing workflow and ability to absorb and retain details.
General knowledge of medical and insurance terminology required.

Nice To Haves

Experience in Epic preferred

Responsibilities

Verify validity of account balances by researching, reviewing, and ensuring accuracy of payment and adjustment posting.
Takes initiative to resolve accounts with and without supervision.
Contact payors, networks, patients, employers, and other responsible parties to acquire timely and accurate/expected payment on assigned Accounts Receivable inventory.
Take necessary steps needed to acquire and provide information needed for claims that have a zero payment.
Use payor-specific contract terms to resolve claims that are in process or have a payment variance.
Refer claims that have a clinical denial to the Denials team for review and follow-up.
Prepare appeal letters to dispute payor denials when appropriate.
Process &/or request rebills and other system actions, as needed.
Understand and apply appropriate system discounts.
Enter all communications regarding patient accounts in the host system.
Accounts should be worked daily, with an emphasis on quality and resolution.
Worklists should be stratified to ensure high dollar and/or aged accounts are the top priority, with the overall goal of resolving assigned inventory each week.
Works toward department goals and visions as an individual and as a team player.
Meet, and maintain, quality and productivity performance metrics set forth by applicable leadership.
Maintain proficiency in the host system.
Review financial assistance application for completion prior to processing.
Determines if application is complete. If incomplete, requests additional documents from consumer by phone, mail, or email following HIPAA privacy guidelines.
Documents, receipt of application in system and creates a Case in Financial Assistance Module. Uses appropriate activity code in Epic to ensure productivity is accurate.
Review incoming applications received by mail, email or MyChart, to determine if all the required information was submitted. If incomplete, requests additional documents from consumer by phone, mail, or email following federal HIPAA regulations.
Processes accounts timely, according to age, and consumer request. Uses appropriate activity code in Epic to ensure productivity is accurate.
Prepare and mails all approval/denial letters.
Prepares documents for scanning, removes non-essential information from packets to protect consumers financial information.
Provide excellent service when dealing with payors, patients, employers, management, hospital staff and other parties within and outside of THR.
Communication should be clear, concise, and professional.
Requests should be addressed timely, with the goal of completion within 3 days to avoid delinquency.
Requests deemed as "escalated" should receive immediate attention.
Identify and resolve problems related to payor contracts and reimbursement in a timely manner.
Inform Business Operations Supervisor, Manager and/or Payor Champion of any potential trends that might delay accurate payment (via appropriate mechanism - spreadsheet, email, etc...)
Recommend accounts for placement with an outside collection/legal vendor when appropriate resolution is not obtained timely.
Compliance with THR policies and procedures.
Complies with all applicable regulations with the operating systems, entity, and system policies and procedures.
Complete assigned tasks in a timely and effective manner.
Maintain up-to-date knowledge of local, state, and federal guidelines for communication and collections.