Assist team by accepting and resolving escalated patient calls. Interact with various sources, including CSC, carrier, and provider when patient responsibility is challenged. Attend meetings with upper management to discuss policy and procedural changes/updates in all areas of CareCentrix. Guides team towards the successful collection of invoice processing activities to ensure receivables are reimbursed on an accurate and timely basis. Handle high profile accounts, and respond to up line entities, including but not limited to, upper management, attorney general, Better Business Bureau, CSC, carriers, and providers. Support upper management in making data driven decisions with accurately run reports, and data analysis. Identify and escalate patient issues and concerns to the appropriate supervisor. Act as back up to supervisor in their absence. Work under minimal supervision.
LEAD PATIENT ACCOUNT SPECIALIST
• Researches, resolves, and documents patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems. This includes communications with internal and external customers. Identify and resolve possible root causes of inappropriate denials. Assures customer agreement by summarizing, and closing each call appropriately.
• Investigates payment status and determines patient’s financial responsibility. Offers patient assistance with financial responsibility, through various financial options, to collect outstanding balances. Takes appropriate action when patient financial responsibility is challenged.
• Identifies overpayments, process refunds, adjustments, and appeals as necessary. Analyzes and clear payment variances, which may involve preparation of adjusted and corrected bills, or adjusting accounts receivable entries in accordance with existing operating procedures. This may include the use of special reporting.
• Accepts escalated patient calls to minimize dissatisfaction by means of attentive listening, maintaining a professional tone, and acknowledging patient concerns. Escalates patient concerns to the appropriate supervisory level when necessary.
• Communicates with provider of service to retrieve appropriate medical documentation, work orders, proof of delivery, or other documentation to resolve open account issues.
• Reviews explanation of payment (EOP), explanation of Medicare benefits (EOMB) and explanation of benefits (EOB) for accuracy of patient responsibility.
• Exercises good judgment, interprets data, and is knowledgeable in the details of all related CareCentrix contracts, including company policies and procedures.
• Maintains teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution.
• Maintains patient confidentiality and data integrity in accordance with Health Information Portability Accountability Act (HIPAA), and company policies and procedures.
• Determines and delivers necessary documentation required by the patient to complete the payment arrangement process. This includes payment plan agreements, or other correspondence; including letters such as Secondary Payer Letters, Medicare/Medicaid Verification Letters, or other documentation to resolve open account issues.
• Follows up on patients’ returned documentation or signed payment agreements, and subsequent account tracking and processing.
• Offers patient assistance through various financial plans, with financial responsibility in order to collect outstanding balances. Takes appropriate action including proper follow up when patient requests assistance in reconciling their financial responsibility.
• Provides guidance and instruction to team and acts as back up to supervisor. Assists the supervisor in distribution of work to the team and completion of special projects.
• Develops training workshops and mentoring programs. Maintains training manuals, scripts, job aids, provide new hire and temporary personnel with training, and Oscars (user access), as well as, the re-education of team as necessary.
• Monitors employee productivity, through company reporting software and databases. Records inbound calls and provide feedback to associates, as required.
• Corresponds with patient through professional letter writing in accordance with corporate guidelines.
• Reviews and processes Patient Waiver Applications. Works with Patient Advocacy Team (PAT) to ensure smooth transition of patient responsibility.
• Transitions accounts to outside collection agencies, and works with liaisons to resolve issues/disputes.
• Facilitates trend analysis reports and communicates results to management. Coordinates the execution of Ad Hoc queries, reconciliation spreadsheets, and analysis of accounts receivables. Monitors team results to ensure alignment with departmental goals.
• Facilitates and gathers necessary data from the RCC and providers: Resources for patient contact with insurance carrier, case managers, customer service representatives, etc. Ensures carrier thoroughly reviews their responsibility and considers any possible reprocessing.
• Works with internal customers to initiate, test, and implement new enhancements or platforms as necessary. Organizes any information that needs to be forwarded to the appropriate associate within the organization.
• Maintains work schedules, queue metrics, and review paid time off (PTO) calendar to ensure proper staffing. Assures the completion and coordination of work in a team member’s absence or as needed to maintain departmental standards.
• May travel to providers/payers to act as an onsite liaison seeking successful resolution of receivables and documenting process improvement initiatives.
• Maintains collections activity schedules and other types of tracking mechanisms to ensure all data is readily available for up line management. Perform accounts receivable denial analysis to identify areas that require improvement.
• Ensures the coordination of invoice activities for designated teams leading to timely reimbursement of receivables using available resources including databases, internet, and telephone. Resolution may include the use of electronic and paper processes, subsequently resolving the returned/rejected payer appeal. Finalizing open complex receivables requires knowledge of a variety of both internal and external system applications.
• Identifies/Resolves the possible root cause of inappropriate denials with payers. Assists, researches, and resolves complicated accounts that require payer point of contact intervention as account has been unresolved for an extensive amount of time.
• Guides internal and external customers encompassing all aspects of insurance, government payer and private pay claims processing educating them concerning the importance of clean claims.
• Utilizes various resources to determine patient’s eligibility, benefits, and receives health plan confirmation. This includes online payer databases, CareCentrix Eligibility platforms, and medical records that may initiate provider or payer recoup/rejection activity. Communicates with internal and external customers as necessary.
• Analyzes and clears payment variances. May prepare adjusted and corrected bills and adjust accounts receivable entries in accordance with existing operating procedures. This may include the use of special reporting.
• Evaluates, analyzes and monitors the processing of invoices and on-line notes, utilizing a windows-based data processing system. Oversees accounts receivable adjustments to resolve overpayments and payment rejections in accordance with standard operating procedures.
• Monitors payer responses and may utilize Microsoft Excel, Microsoft Access and other software to ensure prompt payment.
• Provides details/itemizations of services performed to our payers ensuring timely reimbursement. Contacts providers to retrieve appropriate medical documentation necessary to substantiate services provided after reviewing EOP’/EOB’/EOMB’s for accuracy of patient responsibility.
• Provides input on accounts receivable plans/process improvements and assisting in their implementation.
• Prepares Ad Hoc financial reports for management to use in the evaluation of accounts receivable performance. Ensures and coordinates the execution of Ad Hoc queries, reconciliation spreadsheets and accounts receivable analysis for national payer(s) or clients.
• Facilitates/Participates in teleconferences covering a wide range of topics that enables the NBC to effectively collect account receivables.
• Assesses and implements appropriate training activities for current and new associates. Effectively explains and interprets operational policies and procedures. Monitors team results to ensure they are aligned with departmental goals.
• Works with internal customers to initiate, test, and implement new enhancements or platforms as necessary. Organizes information that needs to be forwarded to the appropriate department within the company.
• Assures the completion and coordination of work in a team member’s absence or as needed to maintain departmental standards. Assists the Supervisor in resolving obstacles and enabling the team to move forward with accounts receivable course of action.
• May travel to payer locations acting as an onsite liaison to document process improvement initiatives leading to successful collections of accounts receivables.
• Maintains collection activity schedules and other types of tracking mechanisms to ensure all data is readily available to management. Performs A/R denial analysis to identify areas that require process improvements.
• Assists the Supervisor in the distribution of work, completion of special projects, HR related functions, and performs other duties as required. Assumes responsibility of supervisor during their absence.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
• Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
• Must be able to remain in a stationary position 90% of the time.
• Occasionally move about the office to access file cabinets, office machinery, etc.
• Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).
• Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.
• Occasionally lift items weighing up to 10 pounds.
High School Diploma or the equivalent plus a minimum of 4-5 years medical claims and reimbursement processing experience generally required. Knowledge of healthcare collection procedures and a variety of system applications, both internal and external is required. Knowledge of Utilization Management and URAC standards. Effective analytical, verbal, written communication, mathematical calculations, and professional judgment skills are required. Knowledge of HIPPA guidelines and the Fair Credit and Collections Act is desired but not required. HCPC, CPT and ICD-9 coding is also desirable advanced competency of Microsoft Office Applications and mathematical calculations. Guidelines exist with some decisions requiring discretion in their application. Strong project management skills desired.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.