Account Representative, Sr

3 weeks ago

Houston, United States Texas Children's Hospital Full time
Job Description

We are searching for a Senior Account Representative - someone who works well in a fast-paced setting. In this position, you will follow-up on all assigned Accounts Receivable accounts to ensure continuity of cash flow and the collection of every collectible dollar with efficient account resolution. The Senior Account Representative is responsible for ensuring reimbursement according to all contractual commitments and government regulations.

Skills & Requirements

• Required H.S. Diploma or GED with a preferred Bachelor's Degree emphasis in business

• Required 5 years revenue cycle experience and 7 years related healthcare experience

Job Duties & Responsibilities

• Initiates timely contact with guarantors/third party payors to follow-up on outstanding receivables. Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and bill/collect on outstanding accounts receivables as specified by current policies and procedures.

• Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes. Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates.

• Ensures that all accounts associated with that guarantor and payor relationship are resolved. Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance. Refers problem accounts to team lead or manager before turning 60 days old if unable to resolve them. Documents the issues in detail and refers to team lead or manager with a recommendation of action needed. Provides continual follow-up by working with team lead or manager to resolve the issue.

• Initiates contact with third party payors to follow-up on outstanding receivables that have been underpaid or denied for payment. Researches the denied claim to determine reason for the denial by contacting the payor and reviewing the Explanation of Benefits (EOB) or Remittance and Status Report (R&S).

• Determines appropriate level of appeal to pursue based on research. Follow-up may require working with team lead and/or manager with Admitting, Billing, Medical Records, Care Management, and Contracting to ensure appropriate documentation is received to support appeal. Composes the appropriate appeal letter identifying reason for denial and explanation as to why Texas Children's Hospital is seeking appeal of denial.

• Maintains Accounts Receivable by following established Departmental Policy & Procedures, Workflows, and Departmental Goals. Maintains assigned accounts receivable at or below specified departmental targets and goals.

• Provides supplemental training to employees on departmental policies and procedures and appropriate billing/collection techniques. Provides supplemental training to new employees which may include evaluating accounts, accessing, and reviewing contract matrix, documentation requirements, escalation process and overall daily routine. Assists with questions from other staff members.
  • Brings ideas and issues to management regarding an employee's ability to perform assigned job duties.


About Us

Since 1954, Texas Children's has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children's hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city's Best Places to Work for ten consecutive years.

Texas Children's comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children's Hospital West Campus, a community hospital in suburban West Houston; and Texas Children's Hospital The Woodlands, the first hospital devoted to children's care for communities north of Houston. We have also created the nation's first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children's Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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