HCMD_Patient Acct Representative_S351

7 days left

Location
Silver Spring, Maryland
Posted
Jan 29, 2018
Closes
Feb 24, 2018
Function
Nurse
Industry
Healthcare
Hours
Full Time
Position Purpose:A highly motivated individual with excellent oral and written communication skills to handle medical claim submission and follow up in an Office environment. The candidate must be detail oriented, possess strong problem solving skills and a good listener to assess/fulfill the needs of our callers. He/she must be flexible, able to multitask, a team player and able to maintain ones composure in a continuously intense environment.

Supports the Mission of Trinity Health and Holy Cross Hospital. Adheres to Mission standards, conducts oneself in a professional, diplomatic, and tactful manner when handling Customers. He/she will show respect, compassion, and provide excellent service to all Customers, Co-workers, and Clients. Actively promotes a healthy environment and core values to HCH'S mission and staff.Job Description Details:

I.  Essential Job Functions

Essential

Job Functions

Performance Measures

Final

Rating

A.                   

Account Billing

1.

Enters information into Claims Administrator (CA)/Caremedic (CM) system and is able to fully use its reporting suite to perform daily job functions.

2.

Handles CA/CM edits and properly escalates new edits, edit trends, or unfamiliar/rare edits to Management.

3.

Clears all CA failed/rejected edits on same workday they generate.  Places all edits that cannot be resolved in one day into the proper hold category.  Ensures that claims placed on hold are all noted in the biller note system in CA

4.

Works with occurrence codes, claim types, modifiers, and all Uniform Bill (UB) fields.   Edits UB claims in order to clear edits and achieve reimbursement. Processes   claim attachments, from payer specific forms, to medical records, to Explanation of Benefits (EOB's) needed with secondary and tertiary claims.

5.

Works all CA/Caremedic holds within timeframe established by Patient Accounting Policy. Ensures that  claims that are pended for information not available to the Rep (such as coding or charge issues) are escalated to management if information is not received in a timely fashion from that department.

6.

Handles  coordination of benefits issues and resequence payer priority correctly.  Follows the rules and regulations that govern payer priority.

Comments: Any rating of Exceeds or Unsatisfactory requires justification.

B.                             

Account Collections

1.

Utilizes Healthquest (HQ) and Receivables Workstation (RWS) system and is able to use their full capabilities to assist in Accounts Receivable collections.

2.

Investigates inquiries regarding misapplied or lost payments and takes the appropriate action. Processes cash transactions and adjustments according to policy.

3.

Interprets payer denials/partial payments/no responses and takes the appropriate action to collect/resubmit/ write off any remaining balance.

4.

Follows up on accounts in a timely fashion as the exact time frame may vary for some payers, but all assigned work through RWS or Work Spreadsheets are worked as instructed by Patient Accounting Management.  .

5.

Makes most efficient use of all resources available to minimize collection time (i.e. uses a payer website instead of making a call, sends appeals/secondary claims through electronic systems instead of mailing paper claims).

6.

Ensures that  all collection actions, detailed notes are recorded through RWS and accurate results codes are added.  Maintains  a list of source of information (payer website, payer phone call) and include data that would make them easy to reference if additional follow up actions are needed (claim # for a status request, Customer Service Rep Name/Reference # for payer phone calls, address an appeal was sent to, etc. ).

7.

Escalates all trends in denial/partial pay/no response issues to Management.

Comments: Any rating of Exceeds or Unsatisfactory requires justification.

C.

Communication

1.

Responds to all internal and external communications in a timely and complete manner, whether received through email, written correspondence, or telephone.

2.

Works with electronic mail and Windows applications, which is utilized to process daily work.

3.

Maintains current job-related knowledge and seeks opportunities to advance that knowledge through continuing education, seminars, workshops, cross-training and other educational offerings. Always takes initiative when confronted with situations they are unfamiliar with.

4.

Attends a minimum of 90% of Departmental meetings/training sessions. Arrives at meetings on time and prepared.  Processes information from meetings/trainings and does not need to have information and guidelines repeated.

5.

Serves as a backup to our customer service support staff during lunch periods and/or other unexpected absences.

Comments: Any rating of Exceeds or Unsatisfactory requires justification.

Essential

Job Functions

Performance Measure

Final

Rating

D.

                                           Trinity/Insurance Application Knowledge

1.

Obtains/maintains access to all relevant Trinity applications that facilitate the most efficient use of time at work.  Is able to use all relevant job related functions of these applications.

2.

Obtains/maintains access to all relevant Payer Websites that facilitate the most efficient use of time at work.  Ability to use all relevant job related functions of these applications.

3.

Researches payer policy changes and maintains up to date subscriptions to payer newsletters or other information sources.   Uses written guidance from payer to suggest changes internally and challenge answers externally.

4.

Maintains good working relationship with Insurance Provider representatives if applicable. 

Comments: Any rating of Exceeds or Unsatisfactory requires justification.

E.

                                           Development

1.

Starts work on time and adheres to Department policies and procedures.

2.

Performs other duties as assigned.

3.

Adheres to organizational and departmental policies/procedures and maintains compliance

4.

Alerts appropriate personnel of safety/security/compliance risks, as well as any abuses of Trinity Health resources.

5.

Maintains a  positive attitude and is open to feedback

Comments: Any rating of Exceeds or Unsatisfactory requires justification.

F.

Guiding Behaviors

1.

We Support Each Other in Serving Our Patients and Communities: Convey compassion and care in serving external and internal customers / constituents; Build collaborative relationships throughout the organization in order to share knowledge, skills, and resources; Focus on finding solutions rather than blaming and complaining; Make decisions in the interest of the UEM; Support decisions, once they are made, both publicly and privately.

2.

We Communicate Openly, Honestly, Respectfully and Directly: Listen to and communicate respectfully with others; Articulate ideas and solutions, clearly and succinctly; Talk promptly and directly to an individual when there is a concern or problem; Build trust through open, two-way communication.

3.

We Are Fully Present: Set aside distractions to center self and assure full attention to each patient, family, and team member; Listen to people to understand the words and their meaning; Openly appreciate the gifts and contributions of others.

4.

We Are All Accountable: Align personal actions, measurable performance, and responsibilities to UEM Mission and Goals; Accept responsibility for actions, decisions
and results; Be accountable for the success of the larger organization; Admit mistakes and limitations while demonstrating a ‘can-do' spirit to achieve results; Contribute at a high performance level to a positive, motivating environment. 

5.

We Trust and Assume Goodness in Intentions: Encourage openness and sharing; Seek first to understand, then to be understood; Ask others with different experiences for their point-of-view; Demonstrate genuine curiosity without judging; Be inclusive - reach
out and embrace all people while living our Mission.

6.

We Are Continuous Learners: Embrace change and prudent risk to find new ways to support the Mission; Encourage new ideas to serve our patients and communities; Provide and accept coaching and feedback; Forgive past problems and use conflict as an opportunity for growth; Develop oneself through a personal learning and development plan.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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