Account Representative - (Museum District)

Overview

At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment. This role is also responsible for providing information regarding denial trends for future prevention.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Collaborates with management to reduce aging of accounts by providing verbal and written communication.

• Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. Collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution.

• Assists with knowledge sharing, payor and department cross training, and provides support to other team members as advised by the manager and/or supervisor.

SERVICE ESSENTIAL FUNCTIONS

• Completes special projects to improve team performance, as assigned.

• Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department's revenue cycle operations.

• Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Reviews third party payor work queues to locate and resolve accounts. Resolves denials as they appear. Documents clear, concise and complete follow-up notes in system for each account worked. Assures accounts are completed and worked at a high level of quality by visually proofreading and monitoring work output.

• Identifies, analyzes and escalates trends impacting accounts receivable (AR) collections.

• Meets and/or exceeds established follow-up productivity goals.

FINANCE ESSENTIAL FUNCTIONS

• Expedites and maximizes payment of insurance medical claims by contacting third party payors and patients. This includes making outbound calls to payors and accessing payor websites.

• Reviews and assesses entire account to determine necessary steps or activity to resolve outstanding denials.

• Performs appropriate billing functions, including claims resubmission to payors.

• Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity or coding related appeals.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on collection procedures of various payors and industry trends. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston M