Revenue Cycle / Patient Accounts Specialist III, Back

In addition to the responsibilities listed below, this position may also be responsible for interpreting broad guidelines 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); verifying and validating insurance coverage; pre-registration contacting of payer; applying insurance to a patient account; interviewing patients to determine coverage; partnering with vendors to find coverage for underinsured and self-pay patients; independently researching databases/work ques and engaging/contacting and mentoring others to ensure determine the availability of third party, workers compensation, and secondary coverage funding options for patient bills; using templates and comprehensive foundational 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 and providing MFA status, providing quality assurance; performing standard and nonstandard collection interactions to defined set of patient accounts and collect payments; monitoring payment plans while determining and recommending if agreements should be sustained or cancelled; approving adjustments authority to handle unique circumstances; documenting process forms and obtaining signatures for service locations with Medicare, Medicaid, new facilities, service offers, or commercial enrollment and setting up financial reimbursement with the Treasury; using comprehensive knowledge of business practices to identify and escalate reconciliation issues while performing quality audits; using comprehensive knowledge providing liaison for system workflows to ensure appropriate bad dept assignment and performs the reconciliation between billing system and the vendor.

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Ensures their own work is in compliance by: adhering to federal and state laws, and applicable compliance standards.
• Ensures accurate patient accounts by: taking inquires from providers, members, attorneys, and other insurance personnel to research and answer standard and nonstandard billing questions.
• Reviews high-risk denials to determine the root cause by: leveraging financial clearance and correct coverage, coding, or billing knowledge and analyzing denials to finds trends and reporting findings while partners with other teams to make recommendations for the senior managers.
• Facilitates performance management initiatives by: following general application of standard strategies to monitor quality and productivity metrics associated with operational improvement to ensure the teams work meet established performance levels and analyzes data and experiential information to generate standard and nonstandard report outs and presents the information to revenue cycle leadership to make next-step determinations. following general application of standard strategies to monitor vendor performance of collections, coding services, Medi-Cal, systems, coverage validation, income verification.
• Facilitates process management initiatives by: using comprehensive foundational knowledge of business practices to coordinate with operations managers, process improvement, IT, clinicians, and health plan managers to plan process improvement projects and identify business needs while also contributing to plans to translate business needs into project requirements that are then used to develop project specifications and action plans.
• Facilitates project management initiatives by: contributes to project execution and management efforts by collaborating with stakeholders across teams to ensure the project is successfully executed and project-based changes are implemented, with guidance.
• Facilitates regulatory reporting by: learning, researching, and applying regulation standards while also reviewing the accuracy of own work and making corrections.
• Facilitates systems management initiatives by: integrating new systems processes with the teams work while providing recommendations for new updates such as testing, validating, and partnering to setup work ques (e.g., flush the system), partnering with other entities.
• Facilitates training by: providing targeted training to peers based on approved curriculum.
• Develops training materials by: using comprehensive foundational knowledge of business practices to identify education and training requirements that reflect revenue cycle changes to develop strategic training content.