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Job Summary:

The Account Resolution I representative is responsible for ensuring all eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the Account Resolution I representative will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The Account Resolution I representative will work collaboratively with other team members to ensure necessary communication and feedback to the departments take place in a timely manner.

Core Responsibilities and Essential Functions:

Duties and Responsibilities
- Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures.
- Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.
- Prepare, maintain, assist with, and submit reports as required.
- Appropriately report on-going problems specific to health system departments, and/or contracts to Team Manager or Team Lead.
- Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for resolution.
- Appeal in accordance with methodology in departmental policy and procedure including using correct grammar and spelling.
- Identify contract issues related to denials and delayed adjudication; communicate those issues to Manager.
- Transmit required documentation to Government and third-party payers for the purpose of resolving payments.
- Ensure all payer contact is fully documented in the appropriate software application.
- Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to your Lead.
- Consistently meet the current productivity standards in addressing and resolving accounts.
- Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues. Teamwork
- Provide individual contribution to the overall team effort of achieving the department AR goal
- Identify opportunities for system and process improvement and submit in team meetings
- Become cross-trained and fill in for other staff as assigned
- Particpate and encourage team collaboration and unity.
- Initiate communication with peers about changes and procedures, convey new relevant information to other team members and management. Administrative
- Professional Communication
- Assure patient privacy and confidentiality as appropriate or required
- Communicate in a professional manner with patients, their families and representatives from third party payor organizations, physicians and their staff, co-workers and management.
- Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies
- Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives
- Department Methods/Procedures/Operations
- Follow department guidelines for lunch, breaks, requesting time off, and shift assignments
- Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies
- Follow JCAHO and outside regulatory agencies mandated rules and procedures
- Utilize assigned menus and pathways in the mainframe system. Report software application problems to the appropriate source.
- Utilize assigned computer hardware. Report hardware problems to the appropriate source.
- Participate in the testing for assigned software applications, including verification of field integrity when needed.
- Perform other duties and responsibilities as assigned

Required Minimum Education:

High school diploma Required or
equivalent Required

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

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 2 years collection experience Preferred

Required Minimum Skills:

Ability to perform mathematical calculations with High-level problem solving, analytical, and investigational skills
Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices including oral and written comprehension and expression
Basic experience and knowledge of PC applications
Detail-oriented, good organizational skills, and ability to be self-directed
Strong time management skills; Ability to learn quickly and meet continuous timelines, managing multiple priorities and a heavy workload in a high-stress atmosphere
Demonstrate flexibility to perform other tasks as needed in an active work environment with changing work needs
Ability and willingness to exhibit behaviors consistent with principles of excellent service
Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment
Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect)

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.