Job Information
National Jewish Health Account Representative in Denver, Colorado
Some call it a career. For us, it's a calling.
National Jewish Health is currently seeking an Account Representative to join our Patient Financial Services team. The candidate selected for this role will be dedicated, detail oriented, approachable, knowledgeable, able to problem solve and motivated. Currently, this position is required to work in our office located in Glendale, CO.
This position will impact the institution with timely and accurate processing of patient accounts receivable billing and collections. The specific job duties are comprised of a combination of responsibilities including billing, claim follow up, claim appeals, patient account resolution, patient advocacy and customer service.
The ideal candidate will display a good working knowledge of systems and processes and will be expected to resolve standard queries and problems. Works on assignments that are moderately complex in nature where judgment is required in resolving problems and making routine recommendations. Knowledge of medical reimbursement policies and procedures. Knowledge of medical terminology and insurance claim procedures common to medical billing and accounts receivable operations. Knowledge of one or more of the following: Medicare, Medicaid, Workers Comp, Managed Care (HMO, PPO, POS, etc.) or Commercial Payors. Knowledge of principles and practices of customer service and telephone courtesy.
As the leading respiratory hospital in the nation, National Jewish Health is pioneering a new era of preventive and personalized medicine. By combining our efforts in comprehensive care, academic education and ground-breaking research, we're able to develop treatments that help our patients live more productive lives. If you believe in working for an organization where Breathing Science is Life, we invite you to join our team.
Position Summary
Responsible for financial resolution of receivables by verifying appropriate reimbursement for services rendered. Achieves by persuasive collection techniques, problem solving, complex mathematical proficiency, resolving eligibility, insurance claims billing, insurance claim follow up and/or other related obstacles, according to the existing procedures for collection and by utilizing all available patient accounting and/or payor software.
Essential Duties
Has a thorough understanding of CPT, HCPCS & ICD-10 codes, HCFA and UB04 claim forms, DRG, insurance benefits including authorizations/referrals. Works daily with automated worklist, ATB and or assigned special projects in the patient accounting system to perform account audits of insurance and patient payments. Utilizes claims editing software and/or payor software to review claims history in order to address and resolve payment delays and/or incorrect payments. Maintains ability to read and comprehend all payors' claims adjudication vouchers, explanation of benefits (EOB), or electronic remittance advice (ERA). Utilizes vouchers, EOBs, and ERAs to help confirm proper processing of claims and appropriate levels of reimbursement. Maintains a current and thorough knowledge of regulatory and procedural requirements related to the assigned account workload. Knowledge of applicable contracted payor documents including the contract matrix and state and federal regulations are required. Regulations include but are not limited to various reimbursement methodologies depending on the services billed and claims editing content. Contacts insurance companies or clients and uses proper negotiation or persuasion techniques to elicit payment promise or account resolution. When necessary, works with billers to perform re-bills or secondary billing. Calendars follow up collection calls and activities, according to existing procedures in order to meet personal productivity and departmental receivable goals. Performs appeals of insurance denials and/or incorrect reimbursement. Facilitates medical record ocumentation submissions when medical necessity is the basis for denial and other required documentation when expected reimbursement is not received. Processes all refunds, payment transfers and adjustments for account workload according to established Patient Financial Services (PFS) policies. Contacts patients when necessary to elicit claims and account resolution. Demonstrates good customer service and is knowledgeable when contacting patients. Identifies self-pay accounts and potential bad debt accounts for referral to outside agencies or attorneys for further collection efforts.
Core Values
Be available to work as scheduled and report to work on time. Be willing to accept supervision and work well with others. Be well groomed, appropriately for your role and wear ID Badge visibly. Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually. Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution. Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures. Wears appropriate PPE as outlined by the infection control policies and procedures. Demonstrates compliance with all state, federal and all other regulatory agency requirements.
Minimum Qualifications
Education: High school graduate or equivalent required. Some college level course work, preferred. Work Experience: A minimum of (2) years of recent and related healthcare