About Texas Children's Hospital
Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.
Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital opening in 2017. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.
To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
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
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.