Patient Account Resolution Specialist

Houston Methodist•Katy, TX

11d

About The Position

At Houston Methodist, the Patient Account Resolution Specialist promptly resolves troubled patient accounts requiring special handling in an exception-based environment, including uninsured and underinsured patients, VIP accounts, and coordination-of-benefit issues. The specialist reviews front-end and back-end revenue-cycle elements to identify where an account became troubled, applies critical thinking to determine resolution opportunities, and creates patient-centric solutions. The role interacts with patients, physicians, hospital and Physician Organization staff and management, outside providers, and staff from other system entities. It also assists management with auditing and quality reviews to support accurate and appropriate billing and account resolution. The position resolves accounts by securing payment, insurance coverage, or third-party coverage; confirming balances or refund amounts; establishing payment arrangements or refunds within management guidelines; and analyzing accounts for errors, adjustments, and credits. It requires professional communication, sound judgment, detailed account documentation, protection of confidential health information, and effective coordination with patients and internal and external stakeholders. The role is day shift, requires business-professional or department-approved attire, may require travel within the Houston metropolitan area, and may require on-call availability during emergencies.

Requirements

High school diploma or equivalent education.
Five years of experience in patient billing/collections or insurance.
Demonstrated skills and competencies necessary to safely perform the assigned job, as assessed through ongoing skills and competency assessments and performance evaluations.
English speaking, reading, and writing proficiency sufficient to perform essential job functions, especially those affecting patient or employee safety or security.
Ability to communicate effectively with patients, physicians, family members, and coworkers using a customer-service focus and positive language.
Advanced knowledge of the patient guarantor account cycle, including hospital and physician charges.
Knowledge of hospital and Physician Organization billing, collections, reimbursement, contractual agreements, appeals processes, and hospital charity programs.
Advanced knowledge of state collection laws and the Fair Debt Collection Practices Act.
Excellent communication and negotiation skills and the ability to work independently and collaboratively with business office staff.
Strong analytical ability to recognize individual patient circumstances and resolution options.
Proficient computer skills and ability to learn and navigate multiple software programs.
Knowledge of professional and hospital system billing software related to cash-posting functions.
Ability to remain calm in stressful situations and demonstrate patience and understanding.
Knowledge of medical terminology and its applicability.
Ability to multitask and remain flexible to meet department and organizational requirements.
Bilingual skills are required if working in the international patient account setting.

Nice To Haves

Hospital revenue-cycle experience is preferred.

Responsibilities

Initiate patient contact by phone and letter and use skip-tracing techniques defined in department guidelines; contact outside providers as needed.
Review the full revenue cycle for patient accounts to determine where issues arose and identify patient-centric resolution opportunities.
Use vendor and provider workflow knowledge and information systems to resolve patient concerns efficiently.
Respond to individual patient account inquiries and deliver professional service to patients, guarantors, representatives, internal stakeholders, and providers.
Analyze clinical and financial data in the electronic health record and use judgment to bring accounts to resolution.
Document every account action and provide balance breakdowns to support the next necessary account action.
Meet or exceed performance expectations for productivity, quality review, aged accounts receivable, and account resolution.
Protect private health information according to HIPAA guidelines and participate in compliance discussions as required.
Secure payments, insurance coverage, or third-party coverage, and confirm account balances or refund amounts.
Maximize collections from insurance companies and outside providers in accordance with contracts and Houston Methodist financial arrangements.
Establish payment arrangements or issue refunds according to management guidelines.
Analyze accounts for errors, adjustments, and credits; issue corrected entries when necessary and update account information.
Follow authority levels for posting adjustments, refunds, and contractual allowances.
Organize time, set priorities, use resources efficiently, minimize incidental overtime, and assist other team members between heavy workloads.
Stay current on payor collection procedures and industry trends; participate in training and review activities and apply new learning.
Communicate ideas and suggestions to improve quality or service and adapt to changing demands.
Contribute to a positive, collaborative work environment and help the team achieve department and organizational results.
Assist management with auditing and quality reviews to ensure accurate and appropriate billing and account resolution.