Hartford HealthCare Corp.
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DescriptionJob Schedule: Full Time
Work where every moment matters.
Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Responsible for the timely and accurate collection of third party pay revenue cycle activities associated with timely collection of third party revenue cycle activities associated with outstanding insurance claims across all Hartford HealthCare hospitals, medical group and homecare to insure optimal revenue cycle performance. The AR Follow Up & Denials Specialist is responsible for resolving unpaid third party balances on $550+ million in active inventory and $70 million in denials through account follow up, appeals and resubmission actions. This position reports directly to the AR Follow UP & Denials Supervisor and works closely with other staff throughout the organization. Keeps abreast of all regulations and standards to insure compliance with governmental/regulatory agencies or third party payers. Assisting the organization to comply with all federal/state guidelines. Responsible to insure high quality, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives.
Key Areas of Responsibility
1. Responsible for the timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials by following up directly with commercial and governmental payors to resolve denials, underpayments and credit balances. These numbers will increase with new acquisitions.
2. Identifies and analyzes denials and payment variances and takes action to resolve account including drafting and submitting appeals, identify specific reason for underpayments, denials and cause of payment delays. Perform due diligence in reconciling outstanding balances ensuring all efforts have been exhausted in resolving issues with payers prior to write-off.
3. Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with standard work
4. Respond to inquiries or follow up on issues and provide information to resolve outstanding balances.
5. Works with leadership to identify, trend and address root causes of issues in the AR. Continually strives to improve quality and productivity by identifying improvement opportunities; recommending and assisting to implement changes where there are opportunities for improvement.
6. Assists in development of standard work to improve accuracy and understanding of processes.
7. Meets or exceeds productivity and quality performance expectations.
8. Providing support for other ad hoc analyses and projects as needed
9. Demonstrates H3W Leadership Behaviors.
10. Continually strives to improve quality and productivity by identifying improvement opportunities; recommending and assisting to implement changes where there are opportunities for improvement.
11. Effectively and continually communicates with peers, management and customers to facilitate the flow of information.
12. Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organizations objectives.
13. Assumes responsibility for self-improvement in collaboration with superior.
14. Maintain effective positive customer service, insuring the needs are met and educating staff on the importance of quality customer service.
· This Job Reports To (Job Title): AR Follow Up/Denials Supervisor
· If applicable, describe nature of supervision of any External vendors, contractors, affiliate organizations, etc.
Assist supervisor with the tracking and monitoring of accounts receivables engagements with small balance, out of state Medicaid and credit vendors as needed.
Requirements and Specifications:
· Minimal: High school diploma or GED
· Preferred: Associate’s degree in health care administration, business management or finance.
· Minimal: 2 -4 years medical billing and/or accounts receivables experience in a facility or professional healthcare revenue cycle setting.
· Preferred: 3+ years of medical billing and/or accounts receivables experience in a large facility or professional healthcare revenue cycle setting.
Licensure, Certification, Registration
· Preferred: AAPC or AHIMA certification
Knowledge, Skills and Ability Requirements
· Epic experience and working knowledge of Resolute Hospital and Professional billing modules preferred
· Understanding of medical and insurance terminology, facility and professional billing/reimbursement practices.
· Familiar with CPT, revenue codes and ICD10 codes
· Excellent analytical and problem solving skills
· Excellent communication skills both written and verbal and interpersonal skills
· Knowledge of state and federal regulations as they pertain to billing processes and procedures
· Knowledge of insurance claim processing and third party reimbursement
· Knowledge and understanding of negotiated agreements
· Demonstrated leadership in establishing and achieving goals
· Ability to communicate effectively both orally and in writing, strong computer and math skills required
· Skill in problem solving in a variety of settings
· Skill in time management
· Ability to work efficiently under pressure
· Ability to operate a computer and related applications such as Word, Excel, PowerPoint, etc.
· Ability to work independently and take initiative
· Ability to demonstrate a commitment to continuous learning and to operationalize that learning
· Ability to deal effectively with constant changes and be a change agent
· Ability to deal effectively with difficult people and/or difficult situations
· Ability to willingly accept responsibility and/or delegate responsibility
· Ability to set priorities and use good judgment for self and peers
· Ability to exercise independent judgment in unusual or stressful situations
· Ability to establish and maintain effective working relationships.
We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.