This position is responsible for resolution of the unpaid AR by all applicable payers of the EMHS Patient Account Services in a Centralized Business Office environment. This position is responsible for resolving outstanding payer balances in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Government and Non-Government payment processing policies. In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of AR Resolution Specialists to analyze and take corrective action on outstanding AR to ensure an optimum revenue cycle workflow.
DUTIES AND RESPONSIBILITIES:
- Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department's policy and procedures.
- Take necessary AR adjustments under the direction of the department's adjustment policy.
- Request relevant information from appropriate revenue cycle and clinical departments as required by payer.
- Complete all returned requests from other departments each day.
- Ensure assigned discharged and final billed accounts are not aging and are escalated timely.
- Advises management of payer processing issues which may require attention in a timely manner.
- Meet or exceed the EMHS performance standards as it relates to quality and productivity.
- Work closely by way of problem solving with peers and leaders to address payer processing issues or changes that directly impact the accounts receivable.
- Ensure all functions related to AR resolution supports the team goals and objectives as well as EMHS's financial performance objectives.
- Thoroughly understand the department's key performance indicators.
- Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.
- Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars.
- Attend internal education sessions to enhance or gain new skills.
- Perform other duties as assigned.
- Adhere to the professional image of EMHS as a competent and reliable employee.
- High School diploma or equivalent required.
- At least one (1) year of healthcare claims AR resolution experience preferred.
- Detailed knowledge of billing and payment rules and regulations in a healthcare setting (Government and/or non-Government payers); multiple hospitals/physician practices preferred.
- Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.
- Experience with EMHS patient accounting software is preferred.
- Must possess strong problem solving skills.
- Ensures all AR resolution functions performed are compliant with applicable laws and regulations.
- Excellent professional communication skills; both oral and written.
- Ability to understand payer processing policies and all applicable billing rules and regulations to facilitate decision making.
- Proficient with Microsoft business applications.
- Customer oriented.
- Demonstrated ability to work independently and collaboratively.
FUNCTIONAL REQUIREMENTS and WORK ENVIRONMENT:
- Sedentary work requiring good manual dexterity. Work involves typing, picking, grasping, occasional stooping, kneeling, crouching, lifting up to 10 lbs., reaching and ability to move about to accomplish tasks. Require repetitive motions of wrists, hands and fingers. Must have excellent hearing and listening skills to receive detailed information through oral communication (via telephone or in person).
- Employee subject to inside environmental conditions. Clean, well-lighted, central heat, central air conditioning. Work is performed in close proximity with others. Some noise level from office machines (printers, typewriters, telephones). Ergonomically correct work station.