POSITION TITLE: Senior Patient Account Rep – Hospital Collections

POSITION SUMMARY:

The Senior Patient Account Rep CBO Operations-Hospital Collections and Denial Management is primarily responsible for ensuring the appropriate action is taken on assigned accounts in a timely manner resulting in positive resolution.

This job description is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

JOB SPECIFICATIONS:

Education:

Minimum Required: High School Diploma

Preferred: Bachelor’s Degree Preferred

Experience:

Minimum Required:

• Three years of experience in healthcare environment, particularly in one or more of the following areas in a hospital business office: billing, collections, payment processing or denial management.
• Epic software experience required.

Preferred: Three years Epic software experience

Special Skills/Training:

• Epic Software
• Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes
• Demonstrates knowledge of:
• Hospital and professional billing processes and reimbursement
• Third-party contracting
• Insurance protocols, delay tactics, systems, and workflows
• ERISA guidelines for denials and appeals
• Regulations related to denials and appeals
• Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
• Possesses efficient time-management skills and proven ability to multitask under tight deadlines
• Demonstrates excellent customer service skills
• Effective writing and communication skills
• Strong comfort level with computer systems

POSITION DUTIES:

Account Follow-Up

• Responsible for accurate and timely completion of daily follow-up and denial account assignment to safeguard reimbursement
• Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement

Denial Processing

• Conducts relevant research to complete appeals process to include assessing, complete and accurate documentation, tracking, responding to, and / or resolving appeals with third party payers in a timely manner
• Analyzes underpayments to identify reasons for discrepancies and process denials and appeals as outlined in payer contracts
• Collaborates with internal departments and external organizations to ensure correct reimbursement and resolve appeals

Analysis

• Initiating improvements and efficiencies by making recommendations and communicating trends and solutions to leadership.
• Reviews posted payments and adjustments to ensure accuracy. Analyzes EOBs to ensure proper reimbursement is received.

Training

• Promotes best practice processes in follow-up and customer service activities and observes and re-educates fellow staff members on latest practices.
• Helps to facilitate staff training that aligns with recognized improvement opportunities and increase understanding of Medicare/Medicaid requirements as well as general follow-up processes
• Serves as mentor and resource to other department staff and is readily available to new hires to supplement training.

Special Projects

• Completes special projects and additional assignments within agreed upon timelines.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.

LCMC Health is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status or any other characteristic protected by law.