University of Rochester Sr Account Representative - Outpatient in Rochester, New York

Opening

Full Time 40 hours Grade 008 Patient Financial Services

Schedule

8 AM-4:30 PM

Responsibilities

Position Summary:

With considerable latitude for independent judgment, the Senior Account Representative is responsible for the follow up and collection of accounts that are complex based on high dollar amounts, multiple payers, unique billing or payment arrangements, specialized services, (e.g. transplants, studies) as well as governmental and/or community contracts. Revenue collection activities focus on all payers which are billed under unique contractual obligations on both primary and secondary levels. Trains new and existing PAO staff on new procedures and acts as point person for complex accounts. Serves as main point of contact in claim resolution process for Strong Memorial Hospital (SMH) clinical staff and outside agencies regarding contractual obligations. Assures on-going positive relations and support of highly-visible unique contracts and arrangements. The Senor Account Representative will represent the department and SMH in a professional manner, protecting confidentiality of patient information at all times.

Responsibilities:

Complex, High Dollar & Specialized Services Account Resolution

  • Through detailed knowledge of all third party payer billing requirements and governmental contracts, independently determines the most effective method to follow up on disputed, unpaid, underpaid or overpaid insurance or contracted service accounts in order to bring about prompt account resolution and revenue collection from complex claims, high dollar claims and specialized services (global transplant, studies and grants, etc.)
  • Identifies and resolves problems related to both primary and secondary accounts which are disputed, unpaid, underpaid or overpaid. Determines cause of problem and initiates corrective action through reviews of electronic medical records.
  • Using tact and finesse contacts and confers with contractual agencies (e.g. Veterans Administration), Department of Health, third party and governmental payers, clinical department providers and staff, Workers' Compensation Board and Health Information Management Coding staff, etc. to resolve accounts.
  • Analyzes accounts and determines if correct proration of revenue has been collected using detailed understanding and application of all payer contracts (primary and secondary). Contacts applicable agency, payer or department for resolution.
  • Independently decides when re-submission efforts are complete, including writing an appeal using applicable content and supporting documentation in order to appropriately influence the highest level of revenue.

PAO Support

  • Acts as a point person for questions from assigned PAO collection and billing staff on payer policies, procedures and methods of revenue collection.
  • Trains new PAO staff on the use of the billing application, payer systems and clearinghouse system. Demonstrates how to apply the knowledge of payer contracts and resources in order to resolve disputed, unpaid, underpaid or overpaid accounts.
  • Provides feedback to Operations Supervisor on results of training of new and existing staff.
  • Provides input for performance assessments (probationary and annual) based on observation, questions, and quality review of work performed.
  • In the absence of the Operations Supervisor, acts as the authority, including responding to payers, patients, and issues referred to the area from hospital departments or Patient Service Representatives.

Designated Support

  • Researches and responds to SMH clinical department inquiries on complex, high dollar and specialized accounts and status of collection activities affecting departmental revenue.
  • Using sensitivity and judgment decides if/when patients are contacted. Resolves complex, high dollar and specialized claim resolution issues due to coordination of benefits (multiple payers), eligibility issues, and authorizations.

Audits, Post-Claim Authorizations and Reimbursement Allocation

  • Resolve accounts identified in third party audits involving retroactive approvals, resulting in adjustments, refunds and subsequent secondary billing.
  • Research, verify or obtain authorizations post-claim submittal requiring detailed knowledge of payer rules, complex account procedures and additional documentation to support payment of services.
  • Determines allocation of reimbursement applicable to multiple providers for global transplant payments and initiates transfer of dollars to each provider.

Payer Relations

  • Identifies need for in-person meetings and phone conferences with third-party insurance representatives due to claim and systems issues requiring prompt attention for complex high dollar accounts.
  • Prepares information for and attend meetings with third-party insurance representatives on claims and systems issues for scheduled in-person meetings and phone conferences regarding complex high dollar claims.

Escalation Process

  • Identify and clarify issues that require management intervention to avoid loss of revenue.
  • Recommends the filing of a formal complaint with the State's regulation commission or agency.
  • Determines when to change the account to a self-pay financial class after a review of previous efforts has not resulted in revenue collection and further attempts would not be successful without patient intervention.

Additional Duties as Assigned:

  • Research and initiate suggestions to Supervisor to streamline processes and training materials.
  • Perform coverage for other positions and other duties of similar scope and complexity in regular combination with this position.
  • Copying, faxing, mailing claims, printing and preparing accounts for being written off.
  • Maintains records for effective reporting.

Qualifications:

Requires an Associate’s degree in Business Administration and 2 years (prefer 4-5 years) experience in hospital billing, accounting, and/or coding; or an equivalent combination of education and experience.

EOE Minorities/Females/Protected Veterans/Disabled

Job Title: Sr Account Representative - Outpatient

Location: Strong Memorial Hospital

Job ID: 209409

Regular/Temporary: Regular

Full/Part Time: Full-Time