Account Resolution Insurance Collector

Shift: Days

Job Summary: Under the direction of the Account Resolution Supervisor and the Director of Patient Financial Services, the Account Resolution Insurance Collector position is responsible for management of accounts so that accounts receivable is minimized. Job duties include but are not limited to ensuring that claims are processed accurately and efficiently so that maximum hospital reimbursement is received from payers; works all denials in a timely manner according to insurance filing guidelines; escalates any account that needs a first level appeal or has had more than 2 denials on the same claim to the Account Specialist; queues claim and provides all documents to the Account Resolution Billers on accounts that needs to be refiled to any payer; works all mail correspondence daily; assisting customers in person or by telephone to resolve issues and questions associated with their account balances; and assisting supervisor in developing, establishing and implementing operational policies and procedures. 

Demonstrates Competency in the Following General Areas:

• Commits to one hundred percent (100%) patient and customer satisfaction by always exhibiting a courteous and helpful manner during interactions with others, including patients, families, visitors, physicians and co-workers. 
• Maintains a general, overall working knowledge of the department’s mission thereby having the ability to provide basic service and support to others, including patients, families, visitors, physicians and co-workers. Recognizes when others are in need of assistance and consistently offers to help when own workload permits. 
• Fully knowledgeable of the comprehensive revenue cycle policies and procedural flow, and able to apply this knowledge to all situations. 

Demonstrates Competency in the Following Primary Duties:

• Monitors accounts via system reminders and various reports to ensure that accounts are processed and followed-up in an accurate and timely manner so that maximum hospital reimbursement is received from payers. Works with both internal and external sources through written and oral communication to resolve any issues associated with reimbursement delays and unprocessed claims. Documents all communication and activities on account appropriately to ensure that account history is maintained.
• Responds to patient questions, inquiries and complaints as needed and documents information on account to ensure that account history is maintained.
• Secures and witnesses all required signatures according to internal policy and regulation as applicable including Release of Information, Financial Assistance Application, Financial Agreement and other attestations as applicable; appropriately documents all activities to account to ensure that account history is maintained. 
• Ensures that all account balances are paid within the guidelines set forth in the JCMH collection policy; appropriately documents all activities on account to ensure that account history is maintained; communicates with both internal and external parties to ensure that they have been notified of payments, changes or issues regarding accounts. 
• Maintains knowledge of assigned insurance requirements to ensure Jackson County Memorial Hospital does not take unnecessary losses or cause the patient to pay unnecessary penalties; reviews online and paper-based insurance and legal resources to ensure that receipts, adjustments and refunds are applied correctly; interacts with external and internal resources using oral and written correspondence to resolve problems.
• Maintains overall working knowledge of the Meditech B/AR and LSS module and Change Healthcare application to ensure Account Resolution area processes are completed in the most efficient manner.
• Creates, prepares and implements electronic procedure manual to ensure that the most efficient and productive methods are being used. 
• Provides backup support and training to Account Resolution Biller position and other Revenue Cycle departments regarding the Account Resolution processes ensuring that daily tasks are performed accurately and efficiently. 
• Prepares Account Resolution area reports on a daily, weekly, monthly or “as needed” basis to ensure that the Account Resolution Supervisor, Director of Patient Financial Services and hospital management are well informed. 
• Keeps Account Resolution Supervisor and Director of Patient Financial Services informed of work activities, needs and problems. 
• Performs job specific duties and all other duties as assigned in a timely and accurate manner.

Professional Requirements:

• Wears identification while on duty; meets dress code standards; appearance is neat and clean. 
• Reports to work on time and as scheduled, uses time and attendance system correctly and completes work within designated time. 
• Attends mandatory meetings; attends and/or reads minutes of other scheduled meetings. 
• Respects patient confidentiality and uses discretion in discussion of patient information.
• Participates in continuing educational activities as deemed appropriate by department’s supervisor, manager or director. 
• Completes annual education requirements in a timely manner including but not limited to a minimum of 8 hours per year of job shadowing in the Admissions, Centralized Scheduling or another Patient Accounting area.
• Follows hospital and departmental requirements for infection control and safety. 

Educational/Experience/Regulatory Requirements:

• Ability to organize work, direct and set priorities, and effectively accomplish required duties with minimal or no supervision.
• Previously worked as an Account Resolution Biller position within the organization. 
• High school diploma or equivalent required. Advanced degree or active pursuit of advanced degree preferred.
• One to two years previous acceptable experience in a Patient Financial Services, Accounts Receivable, Health Information Management or Business office setting preferred. 
• Experience in claims and remittance processing required. 
• Must be able to pass pre-employment testing including but not limited to clerical ability and typing test.
• Intermediate level knowledge of Microsoft Excel, Microsoft Word and/or Microsoft Access preferred.
• Must be able to meet the public in a direct and professional manner.
• Previous work history that demonstrates steady attendance and punctuality is required.

Language Skills:

• Must be able to read & communicate effectively in English.
• Must be able to communicate firmly what is required of patients in regards to their financial status.
• Must be able to communicate (orally and in writing) effectively with patients, doctors and other departments in the institution.

Physical Demands:

• Work may be stressful with regular patient contact. Must be able to meet, communicate, and work with patients and public directly, orally, and in writing.
• For physical demands of position, including vision, hearing, repetitive motion and environment, see attached description. Near visual & hearing acuity required to perform essential duties of position. 
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care..

                                                                                                              FREQUENTLY USUALLY OCCASIONALLY INFREQUENTLY N/A

                                                                                                               (at least 50%) (25 – 49%) (10 – 24%) (10%)

1 Standing/Walking.......................................... X

2 Sitting ............................................................ X

3 Twisting......................................................... X

4 Lifting/Carrying............................................. X

5 Pushing/Pulling.............................................. X

6 Climbing (ascending/descending 

ladders/stairs) ................................................ X 

7 Bending/Stooping.......................................... X

8 Using arm muscles frequently or for 

extended periods............................................ X 

9 Using leg muscles frequently or for 

extended periods............................................ X 

10 Using back muscles frequently or for 

extended periods............................................ X 

11 Potential for wound care or invasive 

procedures..................................................... X 

HOW OFTEN ARE THESE WEIGHTS LIFTED OR CARRIED?

                                                                                                              FREQUENTLY USUALLY OCCASIONALLY INFREQUENTLY N/A

                                                                                                               (at least 50%) (25 – 49%) (10 – 24%) (10%)

2 – 10 Pounds .............................................. X

11 – 20 Pounds ............................................. X

21 – 30 Pounds ............................................. X

31 – 40 Pounds ............................................. X

41 – 50 Pounds ............................................. X

50 Pounds or more ........................................ X

DOES THE JOB REQUIRE?

                                                                                                              FREQUENTLY USUALLY OCCASIONALLY INFREQUENTLY N/A

                                                                                                               (at least 50%) (25 – 49%) (10 – 24%) (10%)

Working in hot, cold or wet surroundings..... X

Working outdoors......................................... X

Working with or near chemicals ................... X

Working near radiation sources .................... X

Working near fumes...................................... X

Working with hazardous waste materials...... X

Operating vehicles or machinery................... X

Using hand tools or power tools ................... X

Wearing protective clothing and 

equipment...................................................... X