Account Resolution 2 MGBO
Wellstar Health Systems

Job Info

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Facility: VIRTUAL-GA
Overview
The Account Resolution II representative is responsible for ensuring all eligible accounts are reviewed appealed within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the Account Resolution II representative will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The Account Resolution II representative will work collaboratively with their Team Lead, Manager and other area Leaders to ensure necessary communication and feedback to the departments take place in a timely manner. The Account Resolution II representative serves as a mentor to Account Resolution I representatives as well as own several inter/intradepartmental projects.

Responsibilities
Core Responsibilites and Essential Functions

Duties and Responsibilities
* Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures
* Execute and assist team members with the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials. Follow Adjustment Policy for denials where efforts have been exhausted.
* Maintain data on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution
* Prepare, maintain, assist with and submit reports as required.
* Track and trend recovery efforts by utilizing various departmental tools. Escalate on-going problems to Manager/Team Lead for appropriate action to resolve.
* Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for appeal
* Identify contract issues related to denials and no response; communicate those issues to the team Manager.
* Provide on-going feedback to clinical staff about denial reasons, appeals and their outcomes, and managed care contractual requirements.
* Transmit required documentation to Government and third-party payers for the purpose of resolving payments
* Ensure all payer contact is fully documented in the appropriate software application
* Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to the unit supervisor
* Consistently meet the current productivity standards in addressing and resolving accounts.
* Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues, avoid excessive deferred accounts. Help Team Lead and Manager educate team appropriately.
* Complete special projects as assigned.

Management
* Provide individual contribution to the overall team effort of achieving the department AR goal
* Identify opportunities for system and process improvement and submit to management
* Demonstrate proficient use of systems and execution of processes in all areas of responsibilities
* Follow the health system's general Policy and Procedures, the Department's Policy and Procedures, and the Emergency Preparedness Procedures
* Become cross-trained and fill in for other staff as assigned. Train new employees.
* Administer quality audits as assigned by Manager or Director.

Administrative
* Professional Communication
* Assure patient privacy and confidentiality as appropriate or required
* Communicate in a professional manner with patients, their families and representatives from third party payor organizations including physicians, physician staff, co-workers, management and clinical staff.
* Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies
* Initiate communication with peers about changes and procedures
* Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives
* Department Methods/Procedures/Operations
* Follow department guidelines for lunch, breaks, requesting time off, and shift assignments
* Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies
* Follow JCAHO and outside regulatory agencies' mandated rules and procedures
* Utilize assigned menus and pathways in foreign software applications. Report software application problems to the appropriate supervisor
* Perform other duties and responsibilities as assigned

Required for All Jobs

Performs other duties as assigned

Complies with all WellStar Health System policies, standards of work, and code of conduct.

Qualifications
Required Minimum Education

High school diploma Required or

equivalent Required

Required Minimum Experience

Minimum 3 years collection experience and/or with a Hospital Information System or PC-based application Required and

Less than 1 year experience as an Account Resolution I or equivalent Required

Required Minimum Skills

Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices to include oral and written comprehension and expression.

Basic knowledge of medical terminology

Ability to perform mathematical calculations with high-level problem solving, analytical and investigational skills

Detail-oriented, good organizational skills, and ability to be self-directed

Strong time management skills. Ability to learn quickly and meet continuous timelines managing multiple priorities and a heavy workload in a high-stress atmosphere.

Demonstrat flexibility to perform other tasks as needed in an active work environment with changing work needs

Ability and willingness to exhibit behaviors consistent with principles of excellent service and team collaboration.

Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment

Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect)

Required Minimum License(s) and Certification(s)

Additional Licenses and Certifications

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