Rep, RCM Accounts Receivable III

Job Description:

• Follow-up on outstanding claims and appeals
• Work escalation views
• Review Vendor Clarification logs
• Provide employee and vendor training
• Acts as a knowledge resource for team members
• Not limited to working Claim Ack Rejections, Claim Edits & Charge Corrections
• Phone patients for payment or payment arrangements
• Print and re-file claims as needed.
• Work correspondence daily.
• Maintain continuing education, training in industry career development
• Exceed productivity standards as outlined by business line
• Answer incoming patient insurance company and physician office telephone calls
• Research/audit patient accounts for further payment or adjustments.
• Work KAM reports as assigned
• Work accounts receivable collector queue with proficiency within 30-60 days of employment
• Work 40-50 accounts daily with > or =90% accuracy rating; meet department productivity standards
• Calculate billing unties and reimbursement amounts
• Maintain strictest confidentiality and adhere to all company policies and procedures
• Other duties as assigned
• Reads and abides by the company’s code of conduct, ethics statements, employee handbook(s), policies and procedures and other corporate mandates, including participation in mandatory training programs
• Reports any real or suspected violation of the corporate compliance program, company policies and procedures, harassment or other prohibited activities in accordance with the reporting policies of the company
• Obtains clarification of policy whenever necessary and may use the resources available through the Compliance, Human Resources or Legal Department to do so
• Support and abide by the values of the company
• Excellence – Going above and beyond to deliver the highest quality care and experience to our patients and teammates
• Collaboration – Being inclusive and supportive of one another to deliver improved outcomes to our patients and teammates
• Ethical Responsibility – Acting with the utmost integrity and doing the right thing, even when nobody is watching
• Engagement – Promote an environment where clinicians and teammates thrive, feel passion and joy for what they do, take care of each other, and are proud of who we are and what we do.

Requirements:

• High School graduate or equivalent
• 3 to 5 years’ experience in a healthcare insurance receivables environment
• Associate or bachelor’s degree in business administration or related field preferred
• Two - three years collection experience required
• Two years posting, coding or accounts receivable collection experience in health care organization is preferred
• Strong mathematical, research, analysis, decision making and problem-solving skills
• Working knowledge of CPT, ICD-9 and ASA codes
• Working knowledge of medical terminology, insurance processing guidelines and laws
• Demonstrates advanced understanding of commercial, Medicare and Medicaid payers
• Strong interpersonal skills and comfortable working with physicians, external customers, hospital staff, co-workers and senior leadership
• Strong verbal and written communication skills
• Team oriented, must have a pleasant disposition and high tolerance level for diverse personalities
• Ability to work independently with limited supervision.
• Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions)

Benefits:

• Paid Time Off
• Medical
• Dental
• Vision
• Life
• Disability
• Healthcare FSA
• Dependent Care FSA
• Limited Healthcare FSA
• FSAs for Transportation and Parking & HSAs
• matching 401(K) Plan
• paid family leave
• 9 observed holidays

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