Account Representative, Sr

2 months ago

Houston, United States Texas Children's Hospital Full time

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.

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