Accts Rec & Denial Spec 2 / PA Third Party Follow Up

Location Detail: 9 Farm Springs Rd Farmington (10566)

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 or HCFA1500 (bills), monitor responses from clearinghouse, review Electronic Fund Transmission (EFT) responses, respond on underpayments or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue cycle activities associated with outstanding insurance balances across all Hartford HealthCare hospitals, medical group and homecare. These duties include the managing of the day-to-day work queue inflow, dashboard monitoring, weekly aging’s, Work in Progress (WIP), account activity assignment, and internal department collaboration with daily productivity and quality standards that are tracked and monitored.

Support and perform high level AR & Denial Specialist tasks to improve operations and problem solve by developing solutions after analyzing data. Maintains a high-level understanding of the operational aspects of the entire revenue cycle as well as the appropriate measures to take in resolving claim issues with payers. This position is responsible for researching insurance company issues, such as network problems, work comp claims, and a variety of special projects.

Keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or commercial payers. Assists the organization to comply with all federal/state guidelines.

Responsible to ensure high quality, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives which is not limited to HHC receiving the appropriate payment.

Position Responsibilities:

Key Areas of Responsibility

Functions as a high-level member of the team that is responsible for the timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials.

When a claim is denied;

A. Takes appropriate action for payment resolution; documents all activity in accordance with standard work

B. Initiates, updates, resolves denials and payment variances and takes action to resolve account including drafting and submitting appeals, identifying specific reason for underpayments, denials and cause of payment delays. Maximizes insurance reimbursement timely with commercial and governmental payers

C. Resolves denials based on contract and/or fee schedule.

D. Performs due diligence in reconciling outstanding balances ensuring all efforts have been exhausted in resolving issues with payers prior to write-off.

E. Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with standard work

F. Prepares research and documentation in preparation for meetings with provider reps that will assist in resolution of payer specific issues.

G. Works with leadership to identify, trend and address root causes of issues in the AR.

H. Improves quality and productivity by identifying opportunities and assisting with workflow changes

I. Assists in development of standard work to improve accuracy and understanding of processes.

J. Consistently exceeds productivity and quality performance expectations.

Effectively and continually communicates with peers, management and customers to facilitate the flow of information. Demonstrates H3W Leadership Behaviors.

Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organization’s objectives.

Assumes responsibility for self-improvement in collaboration with superior.

Maintain effective positive customer service, ensuring the needs are met and educating staff on the importance of quality customer service.

Provides support for other ad hoc analyses and projects as needed

Provide team support during team vacations and unexpected absence

Training support for onboarding of new colleagues.

Functions as Daily Huddle Leader

Performs other duties as assigned

Working Relationships:

This Job Reports To: AR Follow Up/Denials Supervisor

If applicable, describe nature of supervision of any External vendors, contractors, affiliate organizations, etc.:

Assist supervisor with the tracking and monitoring of accounts receivables engagements with small balance, out of state Medicaid and credit vendors as needed.

Qualifications

Education

• Minimum: High school diploma, GED or equivalent
• Preferred: Associate’s degree in health care administration, business management or finance.

Experience

• Minimum: 3 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience
• Preferred: 4+ years of medical billing and/or accounts receivables experience in a large facility or professional healthcare revenue cycle setting.

Licensure, Certification, Registration

• American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification

Knowledge, Skills and Ability Requirements

• Epic experience and working knowledge of Resolute Hospital and Professional billing modules preferred
• Understanding of medical and insurance terminology, facility and professional billing/reimbursement practices.
• Familiar with CPT, revenue codes and ICD10 codes
• Excellent analytical and problem solving skills
• Excellent communication skills both written and verbal and interpersonal skills
• Knowledge of state and federal regulations as they pertain to billing processes and procedures
• Knowledge of insurance claim processing and third party reimbursement
• Knowledge and understanding of negotiated agreements
• Demonstrated leadership in establishing and achieving goals
• Ability to communicate effectively both orally and in writing, strong computer and math skills required
• Skill in problem solving in a variety of settings
• Skill in time management
• Ability to work efficiently under pressure
• Ability to operate a computer and related applications such as Word, Excel, PowerPoint, etc.
• Ability to work independently and take initiative
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning
• Ability to deal effectively with constant changes and be a change agent
• Ability to deal effectively with difficult people and/or difficult situations
• Ability to willingly accept responsibility and/or delegate responsibility
• Ability to set priorities and use good judgment for self and peers
• Ability to exercise independent judgment in unusual or stressful situations
• Ability to establish and maintain effective working relationships

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.