AdventHealth Corporate All the benefits and perks you need for you and your family: • Benefits from Day One • Career Development • Whole Person Wellbeing Resources • Mental Health Resources and Support Our promise to you: Strong regulatory background in anti-kickback, Stark, HIPAA, tax-exempt organization rules and regulations, fair market value and commercially reasonable concepts, and business organizations with an ability to draft and negotiate contracts, and provide legal advice on physician recruitment, employment, retention, compensation practices, affiliation agreements, professional service agreements, practice acquisitions and joint ventures matters, other business relationships, various types of leases including space leases and equipment leases, subpoenas, and garnishment issues. This individual will advise CEOs, executive management, compliance department, and medical staff leadership on a wide variety of health care and legal issues.Shift: Monday- FridayJob Location : RemoteThe role you will contribute: Under general supervision and direction, it's the responsibility of the Account Representative II to bill, follow-up, and manage denials to timely collect on assigned accounts receivable . Daily communicates with team members and manager on assigned projects in collaboration to meet prescribed deadlines. Examines contracts, and learns payer contracts to understand reimbursement methodology to appropriately reconcile patient accounts. Resolves and resubmits rejected claims appropriately as necessary. Processes daily and special reports, unlisted invoices and letters, error logs, stalled reports, and aging claim reports. Reviews previous account documentation, determining appropriate action(s) necessary to resolve avoid denial, and facilitate timely payment. Performs outgoing calls and accepts incoming calls from patients and insurance companies to obtain necessary information for accurate billing, collections, and correction of denials, accurately documenting the patient account. Actively prioritizes all outstanding customer service concerns and accepts responsibility in maintaining relationships that are equally respectful to all. Participates in continuing education, team meetings, and performs other functions as assigned by supervisor/manager. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.The value you will bring to the team: Works with insurance payers to ensure proper billing, collections, or denial management on patient accounts. Depending on payer contract may be required to participate in conference calls, review accounts receivable reports, and compile the issue report to expedite resolution of accounts. Examines contract to ensure proper reimbursement, helps educate team members on inconsistencies in processing, and document any changes contract, if identified. Works follow up report daily, maintaining established goal(s), and notifies supervisor of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments, billing) to appropriately work patient accounts. Assists customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payors and patients regarding status of claim, requesting additional information, etc. Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate. Sends initial or secondary bills to Insurance companies Documents billing, denials and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to supervisor/manager if necessary. Processes administrative and medical appeals, refunds, reinstatements, and rejections of insurance claims. Consistently communications with team members to foster a collaborative atmosphere and engages with supervisor/manager on any potential educational opportunities, providing updates on assigned projects. Attends required scheduled meetings, events, and activities Assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by manager. Helps with training new staff, performs audits of work performed, and communicates progress to appropriate supervisor. Assist the supervisor/manager as requested. Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account Qualifications The expertise and experiences you'll need to succeed: High School Grad or Equiv Required Associate Preferred Ability to use discretion when discussing personnel/patient related issues that are confidential in nature. Ability to be responsive to ever-changing matrix of hospital needs and act accordingly. Working knowledge of the Revenue Cycle and the links between departments: Charge Capture, Consumer Access, PreAccess, HIM, Coding, and Patient Financial Services. Self-motivator, quick thinker, communicates professionally and effectively in Cerner Patient Accounting SSI Claims Scrubber Epic Certified Revenue Cycle Rep (CRCR) Preferred
