Accts Rec & Denial Spec 1 / PA Third Party Follow Up

Work where every moment matters. 

Every day, more than 40,000 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.

Position Summary:

Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 or HCFA1500 (bills), monitor responses from clearinghouse, review EFT (Electronic File Transmission) responses, respond on underpayments or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue cycle activities associated with outstanding insurance balances across all Hartford HealthCare hospitals, medical group and homecare. These duties include the managing of the day-to-day work queue inflow, dashboard monitoring, weekly aging’s, Work in Progress (WIP), account activity assignment, and internal department collaboration with daily productivity and quality standards that are tracked and monitored.

Keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or commercial payers. Assists the organization to comply with all federal/state guidelines.  

Responsible to meet quality standards, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives which is not limited to HHC receiving the appropriate payment.

Position Responsibilities:

Key Areas of Responsibility

Functions as a member of the team that is responsible for the timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials.

When a claim is denied;

A.   Follows up directly with commercial and governmental payors to resolve denials, underpayments, no pays, payor rejections, claim edits and credit balances. 

B.   Reconciles outstanding balances ensuring all efforts have been exhausted (calling insurance companies, using the payer web pages, utilizing payer chat function) in resolving issues with payers prior to write-off. 

C.  Responds to insurance companies inquires for follow up on issues to ensure payment.

D.  Meets productivity and quality performance expectations as provided by leadership.

E.   Documents clear and concise notes in the EPIC system regarding claim status and any actions taken on an account.

F.   Works with leadership to identify, trend and address root causes of issues in the AR.  Keeps leadership informed of any issues or trends.

Communicates with peers, management and internal colleagues to facilitate the flow of information. Demonstrates H3W Leadership Behaviors.

Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organization’s objectives.

Assumes responsibility for self-improvement in collaboration with superior.

Maintains effective positive customer service, ensuring the needs are met.

Performs other duties as assigned

Working Relationships:

This Job Reports To (Job Title): AR Follow Up/Denials Supervisor.

Requirements and Specifications:

Education

·        Minimum: High school diploma, GED or equivalent

·        Preferred: Associate’s degree in health care administration, business management or finance.

Experience

·        Minimum: 1 -2 years medical billing or accounts receivables in a medical facility or professional healthcare revenue cycle setting and/or banking experience

·        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: American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification

Knowledge, Skills and Ability Requirements 

·        Epic experience and working knowledge of Hospital and Professional billing modules preferred

·        Excellent analytical and problem-solving skills

·        Skill in problem solving

·        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

·        Ability to set priorities and use good judgment for self

·        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.