Patient Account Representative, Managed Care Variance - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Under the direction of the Hospital RRC Supervisor/ Manager, the Hospital Patient Financial Services (PFS) Representative is responsible to review all assigned third-party and/ or patient accounts, ensure that responsible payers are billed and remit payment in a timely manner, and to document account/ claim status and actions appropriately in the patient accounting system(s).  Identifies, communicates and escalates complex claim issues, billing/ payment trends, and recommends solutions to leadership. 

PERFORMANCE RESPONSIBILITIES                                                                                                     

• Reviews hospital accounts assigned by system generated work-queues or reports to determine appropriate actions for moving accounts forward in the revenue cycle. Performs those actions such as initiating phone calls, submitting website inquiries, writing letters of appeal to payers and inquiries to patients, recommend write offs and adjustments, ensures that account balances are valued as per payers’ contracts, . all in accordance with department policies and procedures.

• Meets and/or exceeds productivity and quality standards as set forth in the department’s policies and procedures.

• Performs root cause analyses on accounts with a solutions focus; tracks trends and escalates carrier or revenue cycle system issues to the Team Lead and/or Supervisor.

• Participates in projects and audits as directed by leadership; collects and assembles financial documents related to billing and payment to substantiate services and reimbursement.

• Collaborates with internal departments, external vendors, and IT for issue resolution and operational effectiveness.

• Regularly meets with Team Lead/Supervisor to discuss and resolve billing obstacles, reimbursement issue, and process improvements.

• Monitors accounts for timely filing guidelines and prioritizes work accordingly. Ensures claims are compliant, meet payer requirements, and billing errors/ claim rejections are resolved timely so that financial losses are minimized. Escalates and reports any delays inclaims adjudication.

• Assesses payments (or lack of) and adjustments for accuracy and timeliness. Understands and reviews payer reimbursement systems/ contracts to establish accuracy in the A/R.  Reviews regulatory and contract updates to understand impacts to reimbursement from federal, state, and managed care payers.  Corrects transactions and transfers balances to responsible parties as necessary in addition to reporting and documenting on-going issues to management. 

• Promotes and delivers positive patient experience and patient satisfaction

• Performs other duties as assigned

• Adheres to all organizational policies and procedures.                                                                                            

POSITION REQUIREMENTS AND QUALIFICATIONS:                                                                                                    

Education:

High School diploma or equivalent required.

Licensure/Certification:

Industry certification (AHIMA, HFMA, AAPC, etc.)

Skills:

• Competent in a variety of patient accounting systems and associated applications.

• Demonstrates trong knowledge of third party operations and reimbursement structures.

• Knowledgeable in medical terminology, CPT, HCPCS, and ICD10 coding used in healthcare.

• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-paced, and ever-changing service environment with patients, patient’s family, insurance carriers, and leadership.
• Detail-oriented with solid analytical problem-solving skills.

• Excellent customer service skills to communicate effectively with payers, patients, and colleagues.

• Excellent communication skills including oral and written comprehension/ expression.

• Ability to maintain professional conduct and good working relationships with staff, management, and payers.

• Microsoft Office proficiency, subject to testing.

• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the usual and customary.

Experience:       

A minimum of two years' experience in healthcare billing, healthcare customer service, or a related field required.

EHR experience (Epic preferred)

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.