JOB SUMMARY
At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment. This role is also responsible for providing information regarding denial trends for future prevention.
Requirements:
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 20%
- Collaborates with management to reduce aging of accounts by providing verbal and written communication. (EF)
- Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. Collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution. (EF)
- Assists with knowledge sharing, payor and department cross training, and provides support to other team members as advised by the manager and/or supervisor. (EF)
SERVICE - 10)%
- Completes special projects to improve team performance, as assigned. (EF)
- Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department’s revenue cycle operations. (EF)
- Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations. (EF)
QUALITY/SAFETY - 20%
- Reviews third party payor work queues to locate and resolve accounts. Resolves denials as they appear. Documents clear, concise and complete follow-up notes in system for each account worked. Assures accounts are completed and worked at a high level of quality by visually proofreading and monitoring work output. (EF)
- Identifies, analyzes and escalates trends impacting accounts receivable (AR) collections. (EF)
- Meets and/or exceeds established follow-up productivity goals. (EF)
FINANCE - 40%
- Expedites and maximizes payment of insurance medical claims by contacting third party payors and patients. This includes making outbound calls to payors and accessing payor websites. (EF)
- Reviews and assesses entire account to determine necessary steps or activity to resolve outstanding denials. (EF)
- Performs appropriate billing functions, including claims resubmission to payors. (EF)
- Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity or coding related appeals. (EF)
GROWTH/INNOVATION - 10%
- Stays current on collection procedures of various payors and industry trends. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. (EF)
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Qualifications:
EDUCATION REQUIREMENTS
o High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
EXPERIENCE REQUIREMENTS
o Three years of physician billing experience, preferably in a multi-specialty physician practice
CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED
o None
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
o Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
o Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
o In depth knowledge of Current Procedural Terminology, 4th Edition (CPT-4), International Classification of Diseases Ninth Revision (ICD-9), International Classification of Diseases Tenth Revision (ICD-10), and Healthcare Common procedure Coding System (HCPCS) coding
o In depth knowledge of third party payor reimbursement policies and procedures
o Understands payor environment such as managed care, independent physician associations (IPAs), and third-party administrators (TPAs)
o Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process
o Understanding of revenue cycle fundamentals
o Ability to follow-through and handle multiple tasks simultaneously
o Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff
o Good judgment in handling of accounts and ability to apply a professional approach in dealing with patients and insurance companies
o Sharp analytical abilities in order to resolve patient accounts in a timely and correct manner
o Proficient computer skills and ability to learn and navigate multiple software programs
o Ability to remain calm in stressful situations with patience and understanding
SUPPLEMENTAL REQUIREMENTS
Work Attire Yes/No
Uniform No
Scrubs No
Business professional Yes
Other (dept approved) No
On-Call* No
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.
Travel**
May require travel within No
Houston Metropolitan area
May require travel outside No
of Houston Metropolitan area
**Travel specifications may vary by department.
Please note any other special considerations to this job: __________________________
Company Profile:
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
