Hospital for Special Surgery
Accounts Receivable Representative – Customer Service, Full-Time
GENERAL SUMMARY OF DUTIES:
Accounts Receivable representative resolves customer issues/problems in a timely and effective manner. Handles high volume of incoming calls; works closely with numerous hospital departments, MD offices and outside agencies to coordinate customer satisfaction. A/R reps makes outgoing collection calls; prepares patient refunds; accepts credit card payments, and establishes payment plans. Knowledge of medical and insurance terminology is preferred. PRIMARY FUNCTIONS: Reviews and processes correspondence from patients and insurance carriers. Insurance Follow-up with primary, secondary, and tertiary claims. Denial Management to include payer denials and denial solutions. Submitting appeals to carriers for reasons such as medical necessity and bundling Credit Balance Management to include reviewing and resolving payment application errors. Reviews and maintains unbilled charge reports, denial reports, and claim allocation reports. Annotates adjustments/updates to patient accounts. Performs other related duties as required. EDUCATION REQUIRED
REQUIRED KNOWLEDGE, CERTIFICATION / LICENSURE: Computer skills and knowledge of relevant software (Microsoft Office and Excel). Knowledge of medical coding is a plus. QUALIFICATIONS; REQUIRED EDUCATION AND EXPERIENCE: Education: High School Diploma or equivalent, with some college preferred. Experience: Minimum of three years experience in medical billing procedures including registration, charge entry, payment posting, and claim preparation. TYPICAL PHYSICAL DEMANDS: Requires ability to work independently. Involves standing, sitting and walking. Requires normal vision and hearing. Normal office environment. YEARS OF EXPERIENCE REQUIRED Experience in healthcare billing. Proven leadership in previous accounts receivable role. 4 YEARS OF EXPERIENCE PREFERRED 5+ Knowledge of third party operating procedures, regulation, and billing requirements as well as government reimbursement programs. Knowledge of CPT, ICD-10, HCPCS coding and Medical Terminology and Collections. Proficient in uses of computerized registration and billing systems and personal computers, including Microsoft Office Suite. Ability to identify trends with third party payer denials and provide feedback or recommendations for improvement to management. Positive attitude, flexible team player. Strong analytical skills. EPIC experience preferred PHYSICAL WORKING CONDITIONS Sitting in a comfortable position with frequent opportunity to move about. Located in a comfortable indoor area. Examples: executive, management and secretarial positions. ENVIRONMENTAL WORKING CONDITIONS Comfortable indoor area.
Examples: executive, management and secretarial positions. HAZARDS OSHA Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment. POSITION & UNIT ACCOUNTABILITIES Develops/Manages Processes & Systems - Assists with contracts; Assists in the negotiation of physician managed care contracts, analytics, and financial modeling. Upholds Standards/Expectations of HSS Staff - Coordinates enrollment; Coordinates physician enrollment in managed care plans. Upholds Standards/Expectations of HSS Staff - Ensures compliance of managed care companies with negotiated contracts. Upholds Standards/Expectations of HSS Staff - Resolves payor issues; Follows-up and resolving payment issues with Insurance Payors. Upholds Standards/Expectations of HSS Staff - Acts as liaison between physician offices and Insurance Payors. Upholds Standards/Expectations of HSS Staff - Assists with meetings; Schedules, coordinates, and documents for all PHO related meetings. Maintains Documentation & Manages Information - Maintains tracking logs for Insurance Payor issues and accountability for closing out items. Upholds Standards/Expectations of HSS Staff - Oversees PHO phone line, answers and responds to inquiries, and assist with urgent physician office issues. Upholds Standards/Expectations of HSS Staff - Attendance; Maintains satisfactory attendance record. Upholds Standards/Expectations of HSS Staff - Maintains punctuality; Reports for duty punctually. Upholds Standards/Expectations of HSS Staff - Adjusts to change; Adjusts to changing situations and work assignments. EDUCATION REQUIRED High School Diploma or equivalent (G. E.D.), may include specialized or vocational courses EDUCATION PREFERRED Associate's degree or enrolled in college working toward degree. Associates CERTIFICATIONS/LICENSURE REQUIRED
CERTIFICATIONS/LICENSURE PREFERRED
SKILLS REQUIRED
SKILLS PREFERRED Non-Discrimination Policy Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.
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GENERAL SUMMARY OF DUTIES:
Accounts Receivable representative resolves customer issues/problems in a timely and effective manner. Handles high volume of incoming calls; works closely with numerous hospital departments, MD offices and outside agencies to coordinate customer satisfaction. A/R reps makes outgoing collection calls; prepares patient refunds; accepts credit card payments, and establishes payment plans. Knowledge of medical and insurance terminology is preferred. PRIMARY FUNCTIONS: Reviews and processes correspondence from patients and insurance carriers. Insurance Follow-up with primary, secondary, and tertiary claims. Denial Management to include payer denials and denial solutions. Submitting appeals to carriers for reasons such as medical necessity and bundling Credit Balance Management to include reviewing and resolving payment application errors. Reviews and maintains unbilled charge reports, denial reports, and claim allocation reports. Annotates adjustments/updates to patient accounts. Performs other related duties as required. EDUCATION REQUIRED
REQUIRED KNOWLEDGE, CERTIFICATION / LICENSURE: Computer skills and knowledge of relevant software (Microsoft Office and Excel). Knowledge of medical coding is a plus. QUALIFICATIONS; REQUIRED EDUCATION AND EXPERIENCE: Education: High School Diploma or equivalent, with some college preferred. Experience: Minimum of three years experience in medical billing procedures including registration, charge entry, payment posting, and claim preparation. TYPICAL PHYSICAL DEMANDS: Requires ability to work independently. Involves standing, sitting and walking. Requires normal vision and hearing. Normal office environment. YEARS OF EXPERIENCE REQUIRED Experience in healthcare billing. Proven leadership in previous accounts receivable role. 4 YEARS OF EXPERIENCE PREFERRED 5+ Knowledge of third party operating procedures, regulation, and billing requirements as well as government reimbursement programs. Knowledge of CPT, ICD-10, HCPCS coding and Medical Terminology and Collections. Proficient in uses of computerized registration and billing systems and personal computers, including Microsoft Office Suite. Ability to identify trends with third party payer denials and provide feedback or recommendations for improvement to management. Positive attitude, flexible team player. Strong analytical skills. EPIC experience preferred PHYSICAL WORKING CONDITIONS Sitting in a comfortable position with frequent opportunity to move about. Located in a comfortable indoor area. Examples: executive, management and secretarial positions. ENVIRONMENTAL WORKING CONDITIONS Comfortable indoor area.
Examples: executive, management and secretarial positions. HAZARDS OSHA Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment. POSITION & UNIT ACCOUNTABILITIES Develops/Manages Processes & Systems - Assists with contracts; Assists in the negotiation of physician managed care contracts, analytics, and financial modeling. Upholds Standards/Expectations of HSS Staff - Coordinates enrollment; Coordinates physician enrollment in managed care plans. Upholds Standards/Expectations of HSS Staff - Ensures compliance of managed care companies with negotiated contracts. Upholds Standards/Expectations of HSS Staff - Resolves payor issues; Follows-up and resolving payment issues with Insurance Payors. Upholds Standards/Expectations of HSS Staff - Acts as liaison between physician offices and Insurance Payors. Upholds Standards/Expectations of HSS Staff - Assists with meetings; Schedules, coordinates, and documents for all PHO related meetings. Maintains Documentation & Manages Information - Maintains tracking logs for Insurance Payor issues and accountability for closing out items. Upholds Standards/Expectations of HSS Staff - Oversees PHO phone line, answers and responds to inquiries, and assist with urgent physician office issues. Upholds Standards/Expectations of HSS Staff - Attendance; Maintains satisfactory attendance record. Upholds Standards/Expectations of HSS Staff - Maintains punctuality; Reports for duty punctually. Upholds Standards/Expectations of HSS Staff - Adjusts to change; Adjusts to changing situations and work assignments. EDUCATION REQUIRED High School Diploma or equivalent (G. E.D.), may include specialized or vocational courses EDUCATION PREFERRED Associate's degree or enrolled in college working toward degree. Associates CERTIFICATIONS/LICENSURE REQUIRED
CERTIFICATIONS/LICENSURE PREFERRED
SKILLS REQUIRED
SKILLS PREFERRED Non-Discrimination Policy Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.
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