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.

　　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 Methodist reserves the right to revise job duties and responsibilities as the need arises.

　　EDUCATION

　　High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)WORK EXPERIENCE

　　Three years of physician billing experience, preferably in a multi-specialty physician practiceLICENSES AND CERTIFICATIONS - REQUIRED

　　N/AKNOWLEDGE, SKILLS, AND ABILITIES

　　Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

　　Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

　　Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

　　In depth knowledge of Current Procedural Terminology, 4th Edition (CPT-4), International Classification of Diseases Ninth Revision (ICD-9), International Classification of Diseases Tenth Revision (ICD-10), and Healthcare Common procedure Coding System (HCPCS) coding

　　In depth knowledge of third party payor reimbursement policies and procedures

　　Understands payor environment such as managed care, independent physician associations (IPAs), and third-party administrators (TPAs)

　　Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process

　　Understanding of revenue cycle fundamentals

　　Ability to follow-through and handle multiple tasks simultaneously

　　Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff

　　Good judgment in handling of accounts and ability to apply a professional approach in dealing with patients and insurance companies

　　Sharp analytical abilities in order to resolve patient accounts in a timely and correct manner

　　Proficient computer skills and ability to learn and navigate multiple software programs

　　Ability to remain calm in stressful situations with patience and understanding

　　SUPPLEMENTAL REQUIREMENTS

　　WORK ATTIRE

　　Uniform No

　　Scrubs No

　　Business professional Yes

　　Other (department approved) No

　　ON-CALL*

　　*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

　　On Call* NoTRAVEL**

　　Travel specifications may vary by department

　　May require travel within the Houston Metropolitan area No

　　May require travel outside Houston Metropolitan area No

　　Company Profile:

　　As one of the nation’s leading hospitals and academic medical centers, Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. Houston Methodist Specialty Physician Group employs over 800 physicians at more than 150 locations across Houston. Our specialists are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. The combination of clinical service, research and academics ensure patients have access to the latest treatments and technologies while providing the best comprehensive patient care.

　　Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.

　　Houston Methodist is an Equal Opportunity Employer.

　　Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.