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Account Resolution Rep

3 months ago

Worcester, United States UMass Memorial Health Care Full time

Exemption Status:
Non-Exempt

Schedule Details:
Scheduled Hours:
Shift:
1 - Day Shift, 8 Hours (United States of America)

Hours:
40

Cost Center:
99940 - 5430 Patient Financial Services

Union:
SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:
1. Resolve disputed self-pay account balances as identified on relevant follow-up work queues and reports.

2. Resolve self pay account balances that are eligible for a statement but a statement has not generated by accessing the statement skip work queue.

3. Analyze and research accounts to determine root cause of open receivables and determine and execute the best approach for rebilling and timely and accurate resolution (resubmission, adjustment, write-off, or transfer to patient for payment), particularly Disputed Patient Balance accounts, statement skip accounts, and Cosmetic accounts.

4. Corresponds with third party payers, hospital departments, physician offices and patients to obtain information required for account receivable resolution.

5. Initiates telephone calls to patients/guarantors and insurance companies regarding resolution of their self-pay balances.

6. Responds to patient/responsible party inquiries/requests received via telephone, mail and in person by accessing relevant systems. Handles walk-in patients account inquiries on-site and in-person.

7. Identify and report recurring trends in statement skip extension reports and disputed accounts and work with team to implement solutions to prevent future issues. Report root cause to other areas within the revenue cycle when applicable.

8. Utilizes internal and payor technology and resources to support account resolution activities.

9. Understands and utilizes financial counseling price estimates.

11. Processes patient specific requests for physicians, admin, and clinics concerning complex patient inquiries.

12. Documents all actions taken in the billing system.

13. Work assigned workqueues within established protocols.

14. Completes daily statistic summary reports/logs.

15. Complies with established departmental policies, procedures, and objectives.

16. Attends variety of meetings, conferences, seminars as required or directed.

17. Demonstrates use of Quality Improvement in daily operations.

18. Complies with all health and safety regulations and requirements.

19. Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

20. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:
High School diploma required. Three years of relevant work experience, preferably in patient account resolution. Thorough knowledge of third party insurance and medical terminology. Computer skills. Ability to work independently within established functional guidelines and withstand pressure that may arise when dealing with the public, physicians/clinic and staff.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies, including age-specific competencies and their measurements, will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:
Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and