JOB SUMMARY

Responsible for performing payment follow-up activities on patient accounts as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

Conducts appropriate account activity on final billed claims by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online. Continues collection activity until account is resolved, sent to Legal, or disputed. Responsible for maintaining inventory on desks with no backlog. Ensure daily productivity standards of assigned accounts are met.

Requests additional information from Patients, Medical Records, and others upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.

Recognizes potential delays with payors such as corrective actions and responds avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.

Conducts collection activity on previously appealed claims by contacting government agencies, third party payers via phone, email, or online. Provides ongoing appropriate collection activity on appeals until the payer has responded to the appeal.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, collections) procedures and policies  Intermediate skill in Microsoft Office (Word, Excel)

 Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently  Ability to communicate in a clear and professional manner

 Must have good oral and written skills

 Strong interpersonal skills  Above average analytical and critical thinking skills

 Ability to make sound decisions

 Has a full understanding of the Managed Care collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements.

 Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.  Intermediate understanding of EOB.

 Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.

 Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

WORK SET-UP

 Hybrid

 Night shift Schedule with 15% night differentials

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

 High School diploma or equivalent. Some college coursework in business administration or accounting preferred

 2-3 years medical claims and/or hospital collections experience

 Minimum typing requirement of 45 wpm

AR Collection Representative

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