University of Rochester Account Representative - Outpatient - 216662 in Rochester, New York
Account Representative - Outpatient
Strong Memorial Hospital
Full Time 40 hours Grade 008 Patient Financial Services
8 AM-4:30 PM
With latitude for initiative and independent judgment within department guidelines, the position is responsible for managing inpatient/outpatient accounts from the beginning of the billing period through the accurate resolution of the account. Revenue collection activities focus on an assigned payer billed at the primary level. Activities performed will focus on resolving balances on aged insurance accounts which have not been collected through routine billing and collection activities, ensuring the visit balances are set up on the accounts receivable at expected reimbursement, and determining and completing the collection process that will result in payment. Makes independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Maintain a detailed knowledge of billing requirements and regulations to ensure that the process conforms to federal and state regulations. The Account Representative will represent the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information at all times.
Complete follow up activities on unpaid or under-paid accounts by contacting payer representatives or utilizing online systems with insurance companies and other third party payers to obtain payments, research and resubmit rejected claims to primary payers, obtain and verify insurance information.
Follow up on unpaid accounts
For unpaid accounts, check claim status on appropriate payer system or contact an insurance representative to obtain information as to why claims are not paid and steps necessary for processing/payment
Initiate collection phone calls to insurance companies to determine reason for claim denial, or reason for unpaid claim. Address unpaid claims, and solicit a payment date from the payer.
Research and calculate under or overpaid claims; determine final resolution
Re-calculate claim based on fee schedule, APC or APO grouper, appropriate % of charge, or ASC payment methodology, including add-ons
Follow-up with payers on incorrectly paid claims through final resolution and adjudication, including refund of credits
Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers
Work with supervisor/manager on communication to payer representatives regarding payment trends and issues
Work weekly, bi-weekly and monthly reports and Work Lists via calculating and processing transactions such as payer to payer transfers, contractual adjustments, verify that the insurance levels and proration are set up correctly on the system.
Examples of reports:
2nd level report
Medicare and Medicaid credit balance report
Over $10 k report
Utilize a thorough knowledge of inpatient/outpatient billing policies and procedures for primary levels of third party insurance; prepare log and related management reports when needed, price claims to establish the expected reimbursement on the revenue cycle system.
Initiate payer-related accounts receivable report to determine which visits needs special attention and follow up to obtain correct full reimbursement
Billing primary and secondary claims to insurance
Review paper claims prior to billing. Review include potential of high cost, and late charges to facilitate any necessary manual keying into ancillary billing systems (ePaces, Emdeon, Omnipro, etc).
Identify and clarify issues, payment variances and/or trends that require management intervention; share with Operations Supervisor, Senior Operations Supervisor and/or Manager. Assist Inpatient/Outpatient supervisor with Medicare and Medicaid credit balance audits, and third party payor audits
Coordinate responses and resolution to Medicaid and Medicare credit balances
Review all accounts on the Medicaid and Medicare credit balance report:
Request insurance adjustments or retractions
Prepare requests for insurance and patient refunds
Enter Flowcast visit note documenting status or action taken.
Research and respond to third party correspondence, receive phone calls, explain policies and procedures involving routine and non-routine situations. Assist other areas with patient related questions. Communicate with other Hospital departments and with government and commercial insurance companies.
Coordinate with other department within SMH to get claim issues resolved and complete audits.
Associate's degree in Business Administration and 2 years of hospital patient accounting or consumer collections experience, or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience. Ability to type 25 wpm.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled