[Hiring] Account Resolution 1 MGBO @Wellstar Health System

Role Description

The Account Resolution I representative is responsible for ensuring all eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the representative will track and trend recovery efforts by utilizing various departmental tools and appropriately reporting ongoing problems specific to payers, health system departments, and/or contracts. The representative will work collaboratively with other team members to ensure necessary communication and feedback to the departments take place in a timely manner.

Responsibilities

• Collect and resolve payments from insurance companies by working with assigned payers and utilizing Policies and Procedures.
• Execute the denial appeals process, which includes:
  • Receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.
  • Researching and resolving payer rejected/denied claims.
  • Analyzing accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract.
  • Working with clinical staff as needed to follow-up and appeal denials.
• Prepare, maintain, assist with, and submit reports as required.
• Appropriately report ongoing problems specific to health system departments, and/or contracts to Team Manager or Team Lead.
• Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for resolution.
• Appeal in accordance with methodology in departmental policy and procedure including using correct grammar and spelling.
• Identify contract issues related to denials and delayed adjudication; communicate those issues to Manager.
• Transmit required documentation to Government and third-party payers for the purpose of resolving payments.
• Ensure all payer contact is fully documented in the appropriate software application.
• Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to your Lead.
• Consistently meet the current productivity standards in addressing and resolving accounts.
• Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues.

Teamwork

• Provide individual contribution to the overall team effort of achieving the department AR goal.
• Identify opportunities for system and process improvement and submit in team meetings.
• Become cross-trained and fill in for other staff as assigned.
• Participate and encourage team collaboration and unity.
• Initiate communication with peers about changes and procedures, convey new relevant information to other team members and management.

Administrative

• Assure patient privacy and confidentiality as appropriate or required.
• Communicate in a professional manner with patients, their families and representatives from third party payor organizations, physicians and their staff, co-workers and management.
• Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
• Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives.

Methods/Procedures/Operations

• Follow department guidelines for lunch, breaks, requesting time off, and shift assignments.
• Operate office equipment and machinery and utilize ergonomic workstations, equipment, and supplies.
• Follow JCAHO and outside regulatory agencies’ mandated rules and procedures.
• Utilize assigned menus and pathways in the mainframe system. Report software application problems to the appropriate source.
• Utilize assigned computer hardware. Report hardware problems to the appropriate source.
• Participate in the testing for assigned software applications, including verification of field integrity when needed.
• Perform other duties and responsibilities as assigned.

Qualifications

• High school diploma or equivalent required.
• Minimum 2 years collection experience preferred.
• Ability to perform mathematical calculations with high-level problem solving, analytical, and investigational skills.
• Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices including oral and written comprehension and expression.
• Basic experience and knowledge of PC applications.
• Detail-oriented, good organizational skills, and ability to be self-directed.
• Strong time management skills; ability to learn quickly and meet continuous timelines, managing multiple priorities and a heavy workload in a high-stress atmosphere.
• Demonstrate flexibility to perform other tasks as needed in an active work environment with changing work needs.
• Ability and willingness to exhibit behaviors consistent with principles of excellent service.
• Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment.
• Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect).

Required Minimum License(s) and Certification(s)

• Additional Licenses and Certifications.

Benefits

• Join us and discover the support to do more meaningful work—and enjoy a more rewarding life.
• Connect with the most integrated health system in Georgia, and start a future that gives you more.