Revenue Cycle / Patient Accounts Specialist II, Back

In addition to the responsibilities listed below, this position may also be responsible for identifying the most appropriate action from a clear set of alternatives to process and resolve rejections and denials from all insurance payers to ensure service costs are charged; and processing payer denied claim and underpayments; researching, coping, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services); researching databases/work ques and engaging/contacting third parties, workers compensation organizations, and secondary coverage organizations to find funding options for patient bills; using template and working knowledge of business practices to negotiate payment plans and to set terms of pay agreement; providing customer service while explaining the application process, processing applications and disposition, following policy regulations; performing standard collection interactions to defined set of patient accounts and collect payments; agreeing and monitoring payment plans while determining if agreements should be sustained or cancelled; approving adjustments within policy parameters; enrolling and renewing providers in Medicare, Medicaid, and workers compensation and facilitating the overall workload while instructing other staff.

• Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.
• Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.
• Ensures their own work is in compliance by: adhering to federal and state laws, and applicable compliance standards under some supervision.
• Ensures accurate patient accounts by: taking inquires from providers, members, attorneys, and other insurance personnel to research and answer standard billing questions while escalating non-standard questions.
• Assists with performance management initiatives by: following protocols to produce nonstandard reports according to defined quality and productivity metrics associated with operational improvement to ensure own work meet established performance levels and analyzes data and generate standard reports for relevant departments and medical centers to assess performance progress.
• Assists with process management initiatives by: using working knowledge of business practices to coordinate with operations managers, IT, clinicians, and health plan managers to plan process improvement projects and identify business needs while also receiving general directions to translate business needs into project requirements that are then used to develop project specifications and action plans.
• Assists with project management initiatives by: assists with project execution and management efforts by collaborating with stakeholders within and across teams to ensure the project is successfully executed and project-based changes are implemented, with limited guidance.
• Facilitates regulatory reporting by: learning and applying regulation standards while also reviewing the accuracy of own work and making corrections.
• Assists with systems management initiatives by: integrating new systems processes with work while providing recommendations for new updates.
• Facilitates training by: providing broad-based training to peers based on approved curriculum.