Account Resolution 1 MGBO

Account Resolution I Representative

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful : to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

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 utilizing 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

Administrative

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education :

Required Minimum License(s) and Certification(s) :

All certifications are required upon hire unless otherwise stated.

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 workand enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.