Account Resolution Representative

The Account Resolution Representative is responsible for obtaining fiscal resolution of Government, Medicaid HMO, and Commercial insurance claims. Fiscal resolution is accomplished through following governmental regulations and guidelines & commercial insurance contractual agreements to ensure facility is receiving proper payment for services rendered. The Account Resolution Representative is responsible for investigation of claims denials, insurance processing errors, & open no response claims; in addition to verification accounts are with the correct payer liability and balance. The role also requires follow up on previously actioned on denials, escalation of stalled claims, and identification of payer specific trends to escalate with the Hospital Billing leadership team.

Responsibilities

Obtaining fiscal resolution of Government, Medicaid HMO, and Commercial insurance claims; Investigating claim denials, insurance processing errors, and open no response claims; Verifying accounts are with the correct payer liability and balance; Following up on unpaid, underpaid, and credit balance claims using Epic; Performing comprehensive collection actions including contacting patients/parents and insurance companies; Responding to and resolving claim denials by filing appeals; Identifying and escalating denials to RN Auditors; Analyzing payer errors and denials to identify trends; Validating and facilitating release of information requests for patient medical records; Investigating credit balances; Maintaining current knowledge of payer contracts and billing/reimbursement policies; Reviewing and entering adjustment requests

Requirements

High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) required; 2+ years experience in claims follow up, HCFAs and/or UB-04s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOBs required; Basic knowledge of medical records and HIPAA; Basic knowledge of medical terminology and human anatomy and disease processes; Basic knowledge of ICD-10, CPT and HCPCS level II codes; Demonstrates accuracy and attention to detail; Strong problem solving skills; Ability to prioritize, organize and meet deadlines; Excellent verbal and written communication skills; Ability to work independently with minimal supervision; Comfortable making decisions and acting; Ability to multi-task and function effectively in a team environment; Advanced computer skills including Microsoft Office, Adobe, electronic mail and/or electronic health information records systems and proficient keyboarding skills

Nice to have

Associate's Degree or higher in Medical Billing and Coding, Health Information Management, Healthcare Services Management, Health Information Technology preferred; Associate's Degree in a business related field preferred; General pediatric and/or pediatric subspecialty experience preferred; Prior Epic experience preferred

Benefits

Remote position; Flexible schedule