Lead Accounts Resolution Representative

Facility: VIRTUAL-GA

Job Summary:

Under the direction of the Manager of Account Resolution, The Lead assists with planning and coordinating all HB Accounts Resolution department activities for an account receivable portfolio of ~ approximately $375M-$500M, including, but not limited to training employees, as circumstances dictate. The Lead of Accounts Resolution and Denials Management must ensure eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer time frames and are documented appropriately in the patient accounting system, assist with the a continuous improvement work environment, daily operational needs for all governmental and / or non-governmental insurance follow-up related functions and provide the enterprise with denial management and educational support in a variety of departmental and individual settings. The role requires data analysis, trending analysis, workflow design and departmental educational capabilities regarding payor and revenue cycle business related processes.

This role requires a versatile and well-developed understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation and provider / payor appeal requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable portfolios. The core role focus of this position is to ensure that accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Lead must possess the ability to assist with developing and documenting action plans for quick resource deployment, communicate timely with leadership and staff to understand the specific reasons for payment delays. The role requires the ability to effectively and efficiently communicate both orally and in writing to Leadership and staff, multi-task, meet deadlines, enforce organizational policies and procedures, maintain high staff engagement, staff productivity, and effective operational execution. In addition, the Lead will assist with additional Revenue Cycle related tasks and duties as assigned.

Core Responsibilities and Essential Functions:

Maintain a working knowledge of all-departmental billing and follow-up processes and functions, responding appropriately to inquiries from patients regarding accounts, collection issues and hospital policies, to insure a minimal Accounts Receivables inventory.
Demonstrate effective departmental leadership, and provide direction to the Follow-Up staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of operations, review accounts receivables evaluating trends, optimizing workflow and process to reduce AR growth, quickly creating action plans to reduce trends, resolving issues, etc.
Assist staff by providing direction and guidance, creating a team environment through training, recognition/evaluation, and in-service education which produces optimum work habits and job performance
Assist with setting obtainable strategic and short-term goals, maintaining expected level of Lead productivity as well as assisting with performance studies to improve productivity, streamline operations and reduce error rates. Provide staff training and oversight that newly implemented policies and procedures are being followed. Meet deadlines established through interaction with the Manager of Accounts Resolution or other senior leadership.
Review and improve work procedures to ensure that the most productive and efficient methods are used
Monitor progress for each area on a daily basis, utilizing quantitative productivity reports and providing feedback to staff
Provide assistance with departmental projects and presentations, as needed.
Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership.
Resolve complaints and misunderstandings in a timely and appropriate manner while demonstrating the ability to tactfully handle difficult situations through an approach that reflects consistency and fairness.
Must maintain a proficiency of key automated systems that include Epic, Emdeon Claims Master.
Act as an internal resource; resolving problems and providing expertise to other hospital departments
Review write-off requests, miscellaneous cash adjustments, and submits to manager for approval
Maintain Epic assigned work queues to ensure timely (7 days, or as specified) resolution of review requests
Assist with ensuring that defined audits required of accounts receivables are completed accurately and submitted on time.
Collect and resolve payments from insurance companies by working with assigned payers and utilizing established policies and procedures. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract.

Successfully appeal denied accounts and avoid excessive deferred accounts

Must actively participate and support the efforts of the Revenue Cycle Task Force, Monthly Denials Task Force, Monthly Compliance Coding Partnership as well as other committees as assigned.
Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Manager of Accounts Resolution aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public.
Review denial reports; assist with determining significant problems causing rejections and denials; communicate with the Manager of Accounts Resolution the findings and proposes denial prevention solutions
Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt and Collection Act guidelines, Medicare and Medicaid regulations and reimbursement methodology, as well as state and federal laws.
Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities.
Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts.

Assist with the development, processes and efficiency of Insurance Follow-Up policies and procedures to ensure they are comprehensive in nature and current/updated.

Consistent review of current processes to ensure compliance with policies and procedures.
Assist with establishing controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly
Ensure optimal system capabilities by coordinating with IS, providing training, documentation system parameters, challenging systems and obtaining feedback from staff/users.
Assist with updating, editing, revising and communicating necessary changes of said policies and procedures within the department as well as to other necessary areas within WellStar.
Performs other duties as assigned
Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High school diploma or equivalent required
Bachelor's Degree in business, healthcare or related field is Preferred and

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Certified Patient Account Representative (CPAR), Advanced CPAR or equivalent is strongly Preferred

Additional License(s) and Certification(s):

Required Minimum Experience:

Experience as an Account Follow-up Representative II or three (3) years in hospital patient financial services or related area. Required
Must have a thorough understanding of Medicare, Medicaid and/or Commercial: healthcare revenue cycle functions, PFS operations, Medicare, Medicaid and Commercial regulations and reimbursement methodology, collection control points, denials management, payor technical denial appeals and a proven track record of successful performance within the Revenue Cycle is required. Required

Required Minimum Skills:

Strong interpersonal, mathematical, analytical, computer, problem solving and writing skills, with a take charge attitude.
Must be comfortable interacting with physicians and leadership and staff. Must possess strong leadership skills and a desire for continued career / organizational advancement.
Must be able to perform a wide variety of tasks that require independent judgment, ingenuity, and initiative. Competent with MS Word, PowerPoint, and MS Excel is required as critical analysis will be conducted using this technology.
Ability to:
i. establish a climate to achieve optimal performance levels and maintain a cohesive work team
ii. work efficiently under pressure and deal effectively with constant change
iii. operate a computer and related applications
iv. apply appropriate supervisory, management and leadership techniques in an operational setting
v. work independently and take initiative
vi. demonstrate a commitment to continuous learning
vii. deal effectively with difficult people and/or difficult situation
viii. willingly accept responsibility and/or delegate responsibility
ix. set priorities and use good judgment for self and staff