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

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• 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.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• High school diploma or equivalent education
• 2-5 years experience in Medical/Hospital Insurance related collections
• Minimum typing requirement of 45 wpm

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• 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

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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 terminolog

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office/Teamwork Environment
• Ability to sit and work at a computer for extended periods of tim