Patient Account Senior Representative

Conifer Health Solutions•Frisco, TX

1d•$17 - $26

About The Position

JOB SUMMARY The Accounts Receivable Senior Representative is responsible for all aspects of follow-up activity, to include taking appropriate steps to resolve accounts timely. This candidate should have an increased knowledge of the Revenue Cycle as it relates to the entire life of a patient account from creation to expected payment. Representative will need to effectively follow-up on claim submission and; remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. . Participate and assist in special projects as well as provide A/R support to the team. Assist new or existing staff with training or techniques to increase production and quality as well as provide A/R support for the team members that may be absent or backlogged. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving more complex accounts with minimal or no assistance. Senior Representative must have the ability to work closely with management and team members working an inventory of collectible accounts that bring in revenue and possess the the following: Conduct telephone calls utilizing a professional demeanor when contacting payors and/or patients in order to obtain collection related information Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions (may work in multiple systems for clients) Access payer websites and discern pertinent data to resolve accounts Utilize all available job aids provided for appropriateness in follow-up processes Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership Skilled in working with complex medical claim issues Identify and communicate any issues including system access, payor behavior, account/work-flow inconsistencies or any other insurance collection opportunities Compile data to substantiate and utilize to resolve payer, system or escalated account issues Assist new or existing staff with training or techniques to increase production and quality Provide support for team members that may be absent or backlogged

Requirements

Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
Good written and verbal communication skills
Intermediate technical skills including PC and MS Outlook
Strong interpersonal skills
Above average analytical and critical thinking skills
Ability to make sound decisions
Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
Advanced knowledge of UB-04 and Explanation of Benefits (EOB) interpretation
Intermediate knowledge of CPT and ICD-9 codes
Advanced knowledge of insurance billing, collections and insurance terminology
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
High school diploma or equivalent education
2-5 years experience in Medical/Hospital Insurance related collections
Minimum typing requirement of 45 wpm

Responsibilities

Researches each account using company patient accounting applications and internet resources that are made available.
Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online.
Problem solves issues and creates resolution that will bring in revenue eliminating re-work.
Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and and solves re-coup issues.
Requests additional information from patients, medical records, and other needed documentation upon request from payors.
Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection.
Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
Perform special projects and other duties as needed.
Assists with special projects as assigned, documents findings, and communicates results to leaders.
Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging.
Escalates payment delays/ problem aged account timely to Supervisor.
Compile data to substantiate and utilize to resolve payer, system or escalated account issues.
Assist new or existing staff with training or techniques to increase production and quality as needed.
Participate and attend meetings, training seminars and in-services to develop job knowledge.

Benefits

Medical, dental, vision, disability, and life insurance
Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

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