Account Representative

About Texas Children's Hospital

Summary:

We are searching for an Account Representative — someone who works well in a fast-paced setting. In this position, you will provide collections follow-up on all assigned Accounts Receivable accounts to ensure continuity of cash flow and the collection of every collectible dollar with efficient account resolution. It is the responsibility of the Account Representative to ensure that Texas Children's Hospital is reimbursed according to all contractual commitments as well as government regulations. This position will also assist with the application process of charity or payment plans for the guarantors and families who may need this assistance. In addition, this position will be responsible for appealing all underpayments and technical denials within each payor's contractual guidelines as well as government timelines. 

Skills & Requirements

·       Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s Hospital unless approved for a medical or religious exemption.

·       Required H.S. Diploma or GED

·       Required 2 years revenue cycle experience

Job Duties & Responsibilities

·       Initiates timely contact with guarantors/third party payors to collect outstanding receivables. Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures. Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes. Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Ensures that all accounts associated with that guarantor and payor relationship are resolved. Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance. Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager. Refers problem accounts to Sr. Rep, Team Lead or Manager prior to accounts becoming 60 days old. Documents the issues in detail and refers to Sr. Rep, Team Lead or Manager with a recommendation of action needed. Provides continual follow-up. Assists with special projects to ensure that collection, work queue, and departmental goals are met.

·       Initiates contact with third party payors to collect outstanding receivables that have been underpaid or denied for payment. Researches the denied claim to determine reason for the denial by contacting the payor and reviewing the Explanation of Benefits (EOB) or Remittance and Status Report (R&S). Determines appropriate level of appeal to pursue based on research. Follow-up may require working with Sr. Rep, Team Lead and/or Manager in conjunction with Admitting, Billing, Medical Records, Care Management, and Contracting to ensure appropriate documentation is received to support appeal. Composes the appropriate appeal letter identifying reason for denial and explanation as to why Texas Children's Hospital is seeking appeal of denial. Ensure appropriate payor guidelines and timelines are followed for appeal. Escalates appeals to Sr. Rep, Team Lead or Manager to review if there is a strong supporting argument that it should be escalated at payor level. If additional appeals are not warranted, recommends the appropriate action to resolve the account. Documents every collection effort including letters and phone calls prior to releasing the account to the next responsible party or submitting for adjustment. Documentation should specifically explain the cause of the denial or adjustment or why the balance is now moving to the next responsible party.

·       Maintains Accounts Receivable by following established Departmental Policy & Procedures, Workflow, and Departmental Goals. Maintains assigned accounts receivable at or below specified departmental targets and goals. Following established departmental workflows to ensure that all accounts are being worked on in a timely manner. Uses and refers to managed care manuals, the payor contract matrix, letters of agreement, and any other agreements to determine that appropriate discounts are posted to the accounts. Maintains active accounts on assigned work queue(s) at the expected level.