Patient Accounts Receivable Representative I

Overview

Under general supervision this position supports the vision and mission for the University of Maryland Medical Systems, a multi-billion dollar, regional healthcare facility. Expectations include, but are not limited to, Insurance verification, evaluating financial responsibility of patients, updating accounts to a billable/collectible status, researching denials, claim rejections, and delays in reimbursement, utilizing all possible means to resolve accounts, which include contacting patients, insurance companies and other departments. Assists the department by organizing collection procedures and meeting performance goals while adhering to current laws and payer regulations and reducing uncompensated care.

Key Responsibilities

• Works and maintains assigned receivables through work queues, age trail balance reports (ATB's), and special projects to achieve established department goals through resolution of outstanding account balances and reduction of uncompensated care.
• Works with third party insurances to obtain maximum level of cash to reduce receivable.
• Reviews financial references, including guidelines for reimbursement, state and federal regulations, payer-specific reimbursement policies, procedures.
• Ensures correct processing of outstanding insurance claims by: interpreting insurance payer responses, requesting account level adjustments, submitting appeals and claims reconsiderations, evaluating financial responsibility of patients, resolving insurance denials and claim rejections, performing insurance verification.

Knowledge, Skills and Abilities

• Concern for quality and ability to identify errors and implement corrections.
• Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
• Ability to work effectively in a matrix work environment and to manage multiple deadline-driven tasks and projects.
• Minimal knowledge or demonstrated ability to learn and understand HSCRC/CMS regulations, CPT (Current Procedural Terminology), and ICD-10 coding.
• Ability to operate a personal computer is required. Proficiency with the following applications is required: MS Excel, MS Word, and PowerPoint. MS Access, SAS, and Tableau is preferred.
• Ability to handle confidential issues with integrity and discretion.
• Ability to prioritize and manage work in a stressful environment.