Reconciliation Representative

Reconciliation Representative

The Reconciliation Representative performs adjudication of the accounts that have payment and/or denial postings across the Hackensack Meridian Health (HMH) network. This process verifies that the payment received for the account is equal to the expected reimbursement and to identify issues for management regarding significant variances on Accounts Receivable after payment is posted. Timely adjudication of accounts prevents Accounts Receivable from aging and, therefore, achieves the targeted goal on a monthly basis.

Responsibilities

• Reviews organizational billing practices to ensure invoice/claims accuracy and proper revenue recognition.
• Acts as a liaison with other departments to adjust or reconcile financial data.
• Researches customer complaints and makes necessary adjustments and/or recommendations to resolve issues.
• Analyzes and records variances in Epic at time of account adjudication. Accurately and thoroughly documents activity performed.
• Performs account analysis to ascertain the balance on an open account to determine if balance is due from payer or patient. Maintains inventory, adjudicates timely and resolves high priority issues to prevent accounts from aging unnecessarily.
• Processes all denials and correspondence in a timely manner; analyzes, categorizes and routes all denials to initiate an appeal process which ensures maximizes revenue and cash flow.
• Evaluates credit balance for patient and health plan refunds and assesses patient accounts to calculate accuracy of refund. Ensures timely processing of patient refund to avoid patient complaints.
• Researches and verifies validity of daily credit card chargeback.
• Reconciles Managed Care, Medicare and other Governmental payments and/or denials to the explanation of benefits. Performs comparison of EOB to the negotiated rates for accuracy of reimbursement. Posts appropriate allowance due to system calculation discrepancies.
• Communicates issues and causes of manual allowance to management relating to contract management, payer or high volume issues to prevent future occurrence.
• Provides statistical data on payment discrepancies, which enables management to accurately monitor Accounts Receivable activity on an on-going basis. Data provided will be forwarded to Information Technology for contract management correction and/or updates may also result in payer escalation.
• Escalates accounts that need coding or billing review.
• Responds to patient or payer phone inquiries regarding refund process and payment related inquiries.
• Receives and researches Customer Service, front-end and other departments inquiries as needed to resolve specific account issues.
• Performs analytical support to Patient Accounting and Finance staff as it relates to monthly cash receipt and posting. Contacts payers, patients, other departments and/or agencies to secure the appropriate information to properly adjudicate the account.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate's degree with a concentration in Accounting, Finance, Billing, Coding, another related field, or equivalent relevant experience.
• Minimum of 2+ years experience in patient accounting/revenue cycle operations or relevant experience/training.
• Demonstrated knowledge of Managed Care Contracts, Medicare, and Medicaid.
• Possesses beginning to working knowledge of subject matter.
• Proficiency in Google Suite/Microsoft Office applications, SMS, EPIC and/or other hospital billing systems.
• Good analytical skills.
• Excellent written and verbal communication skills
• Excellent interpersonal skills.
• A certain degree of creativity and latitude is required.

Education, Knowledge, Skills and Abilities Preferred:

• Experience in Healthcare.
• Good basic accounting skills.
• Fast and accurate data entry skills.

Licenses and Certifications Required:

• Must successfully pass completion of EPIC assessment within 30 days after Network access granted.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!