Patient Account Representative II

Patient Account Representative II

Bring your passion to Texas Health so we are Better + Together Work Location: Texas Health Corporate, 612 E. Lamar Blvd., Arlington, TX 76011 Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

What You Will Do:

• Receivables Management - Collections
• 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 Receivables Management related to Financial Assistance PAR IIs.
• 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.
• Process 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.
• 50% Focus on Service
• 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.
• 20% Payor Issues
• 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.
• 20% Compliance
• 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.
• 10%QualificationsWhat You Need:
• Education H.S. Diploma or Equivalent Req
• Experience 2 Years Healthcare Revenue Cycle Accounts Receivable Experience, healthcare or related organization. Req
• Skills 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. Experience in Epic preferred
• Supervision Individual Contributor