About Texas Children's Hospital
We are searching for a Team Lead Account Representative — someone who works well in a fast-paced setting. In this position, you will respond to all customer inquiries regarding patient accounts; provide collection follow-up on all assigned accounts to ensure continuity of cash flow and the collection of every collectible dollar with efficient account resolution; ensure reimbursement is according to contractual commitments as well as government regulations. Experienced with backend revenue cycle, multiple out-of-state Medicaid, Tricare and other Government payor experience is a plus.
If you're a match...let's talk!
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 unless approved for a medical or religious exemption.
Required H.S. Diploma or GED with a preferred Bachelor's Degree emphasis in business
Required 5 years' experience in collections with preferred hospital or healthcare collections experience
Job Duties & Responsibilities
Acts as a lead Account Representative, providing guidance to other Account Representatives and Senior Account Representatives. Participates in interviewing candidates. Conducts orientation for new employees and provides input on annual performance reviews, ensuring objectivity and consistency of the evaluations and development plans. Assesses competency of staff and identifies training needs to ensure staff can demonstrate required skills to complete staff assignments effectively. Ensures appropriate staffing levels by determining requirements for daily coverage, developing, and posting work schedules and making appropriate decisions regarding PTO requests to ensure adequate vacancy coverage to meet operational needs. Funnels information between staff and leadership regarding workplace issues, resource needs, incidents, and departmental/organizational events by conducting regular staff meetings, one-on-one conferences, and education.
Initiates timely contact with guarantors/third party payors to collect outstanding receivables. Initiates collection calls to payors or guarantors to verify receipt of claims/statements and collect on assigned outstanding accounts receivables as specified by current collection policies and procedures. Documents the expected payment, the date payment is expected, the check # and amount to be paid. Follows back up according to policy and procedure or sooner based upon the payor or guarantor’s response. Ensures payments received by third party payors are correct and the proper contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Also ensures that all accounts associated with that guarantor and payor relationship are resolved. Analyzes and assesses accounts for uncollectable balances and makes prudent decisions as to send to the external agency in compliance with the specified policy and procedure. Evaluates family’s financial condition and determines eligibility for charity assistance. Refers problem accounts to management prior to accounts becoming 90 days (about 3 months) old. Documents the issues in detail and refers to management or recommends assignment to insurance attorney. Provides continual follow-up on accounts by working with management to resolve accounts.
Receives escalated customer service issues from the Account Representatives prior to the issue being escalated to the manager. Is available to take transferred calls from Patient Service Specialists from customers that request to speak to a supervisor or manager. Performs the necessary investigation and takes the appropriate action necessary to resolve an escalated call (i.e., refund, review of charges, rebill, courtesy discount, or collections of additional funds from guarantors) and documents all actions taken. Escalates calls to the Manager of Patient Services Specialists, when necessary, to avoid a complaint being filed.
Sends accounts to bad debt when warranted and recalls accounts from bad debt when requested. Transfers accounts to bad debt when need be or at the request of management and documents actions. Recalls accounts from bad debt agencies when asked to do so by management or other Patient Financial Services staff and documents actions. Recalls accounts from bad debt, when requested, so insurance coverage can be added and billed by the requester. Actions are to be documented. Responds to inquiries from our External Agencies.
Maintains accounts receivable by following established departmental policy and procedures, workflow, and departmental goals. Maintains assigned accounts receivable at or below specified departmental targets and goals. Following established departmental workflows to ensure all accounts are being worked on promptly. Uses and refers to managed care manuals, payor matrix and hospital policies to determine appropriate discounts and contractual arrangements are posted to the accounts. Maintains assigned accounts receivable that are 90 days (about 3 months) or more at less than 15% of total assigned receivables. Works with the External A/R work queue to ensure the accounts are clean and not in need of any maintenance (i.e., multiple liability bucket balances, etc.).
Actively participates in special assignments, programs, or improvement initiatives with successful outcomes. Actively participates in special assignments, programs, or initiatives relating to departmental performance such as special training in new collection techniques, new laws or payor in-services. Reports to management denial trends or problem issues with payors, processes, or policies that will aid in improving the cash performance or accounts receivable management. Reports to management any issues or trends in delinquent guarantor accounts. Works on special account issues as assigned by management. Participates in payor specific meetings when needed to help resolve issues and improve communication and processes.
Orients new employees and works with them during their probation period to ensure they understand their job functions, policies, and procedures, and identify areas where additional training is needed. At management's request, orients new employees as they work in the system with assigned accounts. Help the new employee understand processes, workflows, policy and procedures, and daily operations. Assists with questions from new employees until they are fully oriented. Brings ideas and issues to management regarding new employee’s ability to use the system.