Account Resolution 2 MGBO

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Job Summary:

The Account Resolution II representative is responsible for ensuring all eligible accounts are reviewed appealed within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the Account Resolution II representative will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The Account Resolution II representative will work collaboratively with their Team Lead, Manager and other area Leaders to ensure necessary communication and feedback to the departments take place in a timely manner. The Account Resolution II representative serves as a mentor to Account Resolution I representatives as well as own several inter/intradepartmental projects.

Core Responsibilities and Essential Functions:

Duties and Responsibilities * Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures * Execute and assist team members with the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials. Follow Adjustment Policy for denials where efforts have been exhausted. * Maintain data on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution * Prepare, maintain, assist with and submit reports as required. * Track and trend recovery efforts by utilizing various departmental tools. Escalate on-going problems to Manager/Team Lead for appropriate action to resolve. * Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for appeal * Identify contract issues related to denials and no response; communicate those issues to the team Manager. * Provide on-going feedback to clinical staff about denial reasons, appeals and their outcomes, and managed care contractual requirements. * Transmit required documentation to Government and third-party payers for the purpose of resolving payments * Ensure all payer contact is fully documented in the appropriate software application * Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to the unit supervisor * Consistently meet the current productivity standards in addressing and resolving accounts. * Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues, avoid excessive deferred accounts. Help Team Lead and Manager educate team appropriately. * Complete special projects as assigned. Management * Provide individual contribution to the overall team effort of achieving the department AR goal * Identify opportunities for system and process improvement and submit to management * Demonstrate proficient use of systems and execution of processes in all areas of responsibilities * Follow the health systems general Policy and Procedures, the Departments Policy and Procedures, and the Emergency Preparedness Procedures * Become cross-trained and fill in for other staff as assigned. Train new employees. * Administer quality audits as assigned by Manager or Director. Administrative * Professional Communication * Assure patient privacy and confidentiality as appropriate or required * Communicate in a professional manner with patients, their families and representatives from third party payor organizations including physicians, physician staff, co-workers, management and clinical staff. * Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies * Initiate communication with peers about changes and procedures * Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a profes